Achilles Tendon Rupture

• Most commonly occurs in males age 30-50 years that participate in occasional high intensity sports that are associated with jumping or quick starts.  [i.e.: Basketball, racquetball, tennis, squash, etc].
  • Exact mechanism is a sudden eccentric force that is applied to a dorsiflexed foot.
• Rupture is also associated with fluoroquinolone and glucocorticoid use.
• Patient will often hear or feel a sudden snap in the back of the ankle or calf.
• Typically ruptures 2-6cm proximal to its insertion on to the calcaneous where its blood supply is the least.
• On physical exam:
  • the patient is unable to plantar flex the foot, raise up on toes, and may have calf swelling. 
  • You may be able to palpate a gap in the achilles tendon.
  • Two specific tests for achilles tendon rupture.
    • Thompson test:  with the leg extended and the foot in neutral position, squeeze the calf muscles.  A positive test is when the foot does not plantar flex when the muscles are squeezed.
    • O’Brien needle test:  Insert a small gauge needle perpendicular to the skin into the proximal (about 10 cm from the calcaneous) achilles tendon. Passively dorsiflex and plantar flex the ankle and foot. If the needle moves in the opposite direction of the movement then the achilles tendon is intact.
• Treatment
  • Refer to orthopedics
  •  Place the patient in a posterior splint with the foot and ankle in slight plantar flexion. 
    • Ideally this will bring the two tendon ends together and speed healing.

This addition was sent in my Dr. Andrew Milstein:

Thanks for the Orthopedics update.  A few pearls for Achilles Tendon Rupture --> often these patients may present like a typical ankle sprain patient and are placed in a hallway chair.  You can't do an adequate Thompson Test while someone is sitting in a chair.  If you're concerned, lay them down on a stretcher to do the test.