Скачать или смотреть Achilles Tendon Rupture Symptoms, Diagnosis, and Treatment

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Achilles' tendon rupture usually occurs during sporting activities, especially in the weekend warrior.
During the injury, the patient feels a pop or a sensation of being kicked in the back of the heel. After that, the patient will be unable to walk, will have weakness and some ecchymosis.
Usually, the rupture occurs at four to six centimeters above the calcaneus insertion.
It's in the area where the blood supply of the Achilles tendon is limited.
From 10% to 25% of Achilles tendon ruptures can be neglected, missed or chronic. That usually occurs in an older and overweight patient.
He can feel a gap or a defect. You will find weak plantar flexion.
Patient will have a positive Thompson test. No ankle plantar flexion when the calf is squeezed.
The prone exam is better. You will find increased resting dorsiflexion posture in the injured ankle.
You will get an X-ray to see if there is any associated pathology. Some may try to get an ultrasound or an MRI.
The diagnosis of Achilles tendon tear is usually a clinical diagnosis.
The MRI may be helpful, especially if you are not sure. You can see the retracted tendon. You can see the location and the relationship of the tendon ends together in case you're gonna go non-surgical.
The MRI may be important in case of chronic rupture of the tendon.
The best non-surgical treatment is functional rehab with early motion. They find that the functional rehab with early motion is better than a cast in increased range of motion, in faster return to work and also lower rerupture rate.
What is the functional rehab with early motion? You'll immobilize the patient initially in a resting gravity equinus or in about 20 degree plantar flexed position. You do that for up to two weeks, and that is followed by early physiotherapy with appropriate protection and gradual dorsiflexion to neutral.
Why use 20 degree plantar flexion in the immobilization? Because this is the optimal position, and probably to maximize the perfusion and to approximate the tendon ends together.
And when you compare early functional rehab to surgery, the two have similar plantar flexion strength, similar rate of rerupture, but early functional rehab has fewer complications than surgery.
Traditionally, surgery can be done through a posterior midline approach or a posteromedial approach.
In general, wound complication is about 7% to 8% after surgery.
In surgery, you approximate the torn ends and you protect the patient after surgery with a splint.
The optimal position is about 20 degree plantar flexion.
The surgery is done because surgery decreased the risk of tendon rerupture.
Because of that high incidence of complication, percutaneous techniques have been developed to lower the rate of wound complication. The percutaneous and the open techniques have similar results, similar return to work rate, rerupture rate, calf diameter and plantar flexion strength.
So in general, the percutaneous Achilles tendon repair has less risk of wound complication than open technique, but they have a higher risk of sural nerve injury.
Early functional rehab has a similar rerupture rate compared to surgical intervention.
Early functional rehab is a reasonable option for the treatment of acute Achilles tendon rupture, not just for the elderly and inactive people, but also can be a good option for the young, for the healthy and for the active people.
What is the complication of Achilles tendon repair? Wound complication, 7% to 8%. What are the risk factors? Smoking, diabetes, steroids, open technique.
If there's an infection, you will debride the necrotic tissue. Give culture-specific antibiotics for about six weeks, and you don't repair the tendon.
Another complication, sural nerve injury, it occurs more with the percutaneous technique. Another complication is tendon rerupture. It used to occur more with conservative treatment, but nowadays with early functional rehab, there's really no difference compared to surgery. But if rerupture occurs, the patient will probably need surgery.
One complication could be expected for every seven patients treated surgically.
Quizzes
1. What activity commonly leads to Achilles tendon rupture?
a) Swimming
b) Cycling
✔️ c) Sporting activity (weekend warrior)
d) Walking downstairs
Explanation: Achilles tendon rupture often occurs in recreational athletes during sudden acceleration.

2. What sensation is commonly felt at the time of rupture?
a) Burning pain
✔️ b) Pop or kick in the heel
c) Cramping
d) Numbness
Explanation: Patients often describe a pop or sensation like being kicked in the back of the heel.
3. Where does the Achilles tendon most commonly rupture?
a) At the calcaneal insertion
✔️ b) 4–6 cm above insertion
c) In the gastrocnemius
d) At the musculotendinous junction
Explanation: Most ruptures occur in the hypovascular zone 4–6 cm proximal to the insertion.