Achilles Tendon Rupture

Question 1

What are risk factors/

Answer 1

Sports stressing the Achilles - basketball, tennis etc
Increasing age
Existing achilles tendinopathy
Family history
FLUOROQUINOLONE abx
systemic steroids

Question 2

How soon after starting fluoroquinolones can rupture occur

Answer 2

within 48 hours

Question 3

What is the presentation

Answer 3

Sudden onset pain in achilles or calf
SNAPPING sound and sensation
Feeling as though something has hit them in the back of the leg

Question 4

Give signs on examination

Answer 4

When relaxed in a dangled position, the affected ankle will rest in a more dorsiflexed position
Tenderness to the area
A palpable gap in the Achilles tendon (although swelling might hide this)
Weakness of plantar flexion of the ankle (dorsiflexion is unaffected)
Unable to stand on tiptoes on the affected leg alone
Positive Simmonds’ calf squeeze test

Question 5

What is Simmonds calf squeeze test

Answer 5

Pt is positioned prone or kneeling with the feet hanging freely off the end of the bench or couch. When squeezing the calf muscle in a leg with an intact Achilles, there will be plantar flexion of the ankle. Squeezing the calf pulls on the Achilles.
§When the Achilles is ruptured, the connection between the calf and the ankle is lost. Squeezing the calf will not cause plantar flexion of the ankle in a leg with a ruptured Achilles. A lack of plantar flexion is a positive result.

Question 6

What investigation

Answer 6

USS

Question 7

What is immediate management

Answer 7

Rest and immobilisation
Ice
Elevation
Analgesia

Question 8

What is non-surgical management? What is the advantage and disadvantage?

Answer 8

Specialist boot is used to immobilise the ankle. Placed in full plantar flexion then over time gradually altered to back in neutral position
Advantage - avoids risks associated with surgery
Disadvantage - higher risk of re-rupture

Question 9

What are surgical options?

Answer 9

Surgically reattaching the Achilles