Achilles Tendon Rupture

Tears of the Achilles tendon are most often encountered in males 40 to 60 years old. The most common mechanism of injury is sudden, forceful eccentric loading of the tendon. This can occur from a sudden forceful push-off from a single foot, or landing on a single foot. Patients present due to sudden onset pain in the posterior heel and decreased push-off strength. Patients often describe a feeling of being kicked or hit in the heel, often hearing or feeling a pop at the time of injury. Examination may reveal a palpable gap in the tendon, usually distally. Thompson's test is positive, with no ankle plantar flexion when the examiner squeezes the calf. Imaging studies are not typically needed to make an accurate diagnosis of Achilles tendon rupture.

Both surgical and nonsurgical treatment options exist (McComis et al., 1997; Weber et al., 2003). Patient selection and including the patient in the decision-making process are important. Generally, younger patients who desire or require greater posttreatment push-off power are likely to be good surgical candidates, whereas older patients or patients who require less push-off power are nonsurgical candidates. Nonoperative risk of repeat rupture is as high as 10%, versus up to 2% with surgery. Skin necrosis of the surgical wound occurs in 5% to 10% of patients.

Conservative treatment entails a period of immobilization accomplished through casting or brace use, usually 8 to 10 weeks; early weight bearing is controversial. After immobilization, progressive rehabilitation to regain motion, strength, and proprioception is initiated. Surgery is associated with improved push-off power and reduced rate of repeat rupture and generally allows for the best functional recovery (Wong et al., 2002).

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