Achilles tendon rupture

Background

• Most frequently ruptures 2-6cm above calcaneus (where blood supply is weakest)
• Typical pt is 30-50yr old man who participates in strenuous activities on occasional basis
• Quinolone associated rupture occurs in only 12 per 100,000 treatment episodes

DDX

• DVT
• Compartment Syndrome
• Gastrocnemius Strain
• Calcaneal bursitis

Clinical Features

• Sudden, severe pain typically with rapid acceleration or pivoting
• May hear a "pop"
• Inability to run, stand on toes, or climb stairs
• Palpable defect in Achilles tendon 2-6cm proximal to calcaneus (SN 73% and SP 89% for partial tear)
• 20-30% of ruptures will have some amount of active plantar flexion or be able to walk
• Thompson test (SN 96% and SP 93%)
  • Lay pt prone w/ knee bent at 90'
  • In normal pt, squeezing calf results in plantarflexion

Treatment

• Short leg cast w/ ankle slightly plantarflexed
• Ortho referral

Source

• Tintinalli