Achilles tendon rupture

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Background

  • Most frequently ruptures 2-6cm above calcaneus (where blood supply is weakest)
  • Typical patient 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, and risk may be equivalent to oral steroids or non-quinolone antibiotics [1]

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

Differential Diagnosis

Calf pain

Evaluation

Ultrasound of achilles tendon rupture, long axis view[2]

Thompson test

(SN 96% and SP 93%)

  • Lay patient prone with knee bent at 90°
  • In normal patient, squeezing calf results in plantar-flexion

Management

Disposition

  • Outpatient with ortho referral

References

  1. Seeger, et al, "Achilles tendon rupture and its association with fluoroquinolone antibiotics and other potential risk factors in a managed care population." PMID: 16456878
  2. http://www.thepocusatlas.com/musculoskeletal/