rupture of the Achilles tendon


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rupture of the Achilles tendon

Disruption of the attachments of the gastrocnemius and soleus muscles to the posterior calcaneus, an injury that typically occurs in middle-aged male athletes participating in basketball or other ball sports, some divers, or patients treated with steroid injections for Achilles tendinitis.

Etiology

The injury typically occurs during sudden, forceful plantar flexion of the ankle.

Symptoms

After an initial sensation of being struck in the back of the lower limb, the patient typically reports an inability to push up onto his or her tiptoes. The injury is distinguished from others by placing the patient in a prone position with feet extending off the foot of the examining table. The examiner then squeezes the calf muscle and observes the response: if plantar flexion occurs, the tendon is intact; if ankle dorsiflexion results, the tendon is partially intact; if no flexion of any kind occurs, the tendon is ruptured (the Thompson Test).

Treatment

Management may involve casting the lower extremity, but usually surgical repair or reinforcement of the damaged tendon is required.

Patient care

The patient is taught to keep the leg elevated for 48 to 72 hr following the injury, with ice applied intermittently to the joint (or cast) to help control swelling. Nonsteroidal anti-inflammatory drugs (NSAIDs) are provided for pain and inflammation. The patient is fitted for crutches or a walker-frame and instructed in gait training. Rehabilitation exercises consist of flexibility, strengthening, and balance exercises as tolerated. Assisted motion of the ankle reduces the duration of rehabilitation from Achilles tendon rupture, which may in some instances be prolonged or complicated by muscle atrophy or repetitive injury to the tendon.

See also: rupture
References in periodicals archive ?
Smaill GB: Bilateral rupture of the Achilles tendon.
Hestin D, Mainard D, Pere P, et al: Spontaneous bilateral rupture of the Achilles tendons in a renal transplant recipient.
Baruah DR: Bilateral spontaneous rupture of the Achilles tendons in a patient on long-term systemic steroid therapy.