Achilles tendon ruptures occur most commonly during sports. There is a male predominance occurring in the third to fifth decades. The mechanism is frequently push-off occurring during sprinting and jumping sports resulting in violent ankle dorsiflexion. The patient often describes a sensation of "being kicked in the calf or heel."
The patient's calf and Achilles tendon should be palpated for continuity. Ecchymosis and swelling should be noted. The Thompson test should be done by placing the patient prone and squeezing the calf muscles. This should indirectly plantarflex the foot if the Achilles tendon is intact. The Thompson test is positive if the foot does not plantarflex. If the Thompson test is equivocal, then the O'Brien's test can also be done. This is done by placing a needle in the tendon proximal to the suspected area of rupture and passively ranging the ankle. If the needle hub moves in the opposite direction of ankle movement, this confirms an intact tendon distally. Finally, the hyperdorsiflexion sign should be noted. With the patient prone, both knees are flexed to 90 degrees while the examiner maximally dorsiflexes both ankles comparing the injured to the uninjured side.
Approximately 20% to 25% of Achilles tendon ruptures are initially misdiagnosed. MRI or ultrasonography are not routinely needed for diagnosis but can be helpful in surgical decision making.
Other disease-related factors that place people at greater risk of Achilles rupture include rheumatoid arthritis, lupus erythe-matosus, hypercholesterolemia, gout, dialysis, renal transplant, steroid therapy, endocrine dysfunction, infection, tumor, autoimmune disorders, diabetes mellitus, and the use of fluoroquinolones.
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