Achilles Tendon Rupture (GOLD)

Question 1

Where does rupture to the Achilles Tendon Typically occur?

Answer 1

1 - 2 inches above the tendinous insertion on the calcaneus

Question 2

Most likely cause of achilles tendon rupture? (Movements)

Answer 2

Unexpected dorsiflexion while weight bearing

or

Forceful eccentric contraction of the plantar flexors

Question 3

Most likely cause of achilles tendon rupture? (Structural)

Answer 3

• Poor stretching routine
• Tight Calf Muscles
• Improper shoe wear

Question 4

Most likely cause of achilles tendon rupture? (History and What Age)

Answer 4

• > 30 y/o (decreased blood flow to the tendon)
• Hx of corticosteroid injections

Question 5

Clinical Presentation

Answer 5

• Swelling over the distal tendon
• Palpable defect
• Pain and weakness with plantar flexion

Question 6

What may a patient subjectively state during evaluation?

Answer 6

They heard a “pop” or “snap” associated with severe pain.

Question 7

What special test may be done to confirm diagnosis?

Answer 7

(+) Thompson Test: not demonstrating PF with squeezing of the affected calf muscle.

Question 8

Are men or women more susceptible in developing Achilles Tendon Rupture? What special group are most likely to develop a rupture?

Answer 8

Men

Those who do not exercise regularly, “Weekend Warriors”

Question 9

Most effective management?

Answer 9

Immobilization through casting with surgical repair or reconstruction

or

Non-surgical repair with serial casting (10 weeks), followed by use of heel lift (3 - 6 months)

Question 10

What approach has higher rates to return to athletic activities? Surgical or Non-Surgical

Answer 10

Surgical!

Question 11

Re-Rupture rates for surgical vs non-surgical approach?

Answer 11

Surgical: 0-5%
Non-Surgical: 40%

Numbers are more of a take home to show how surgical approach is the most beneficial!

Question 12

Are flattened or high arches associated with increased incidence of achilles tendon rupture?

Answer 12

Flattened arches