MANUAL MINORS
An Achilles tendon rupture is a serious injury where the tendon connecting the calf muscles (gastrocnemius and soleus) to the heel bone tears partially or completely. It is most common in active individuals, particularly those aged 30 to 50, and typically occurs during sports activities involving jumping or sudden changes in direction. Symptoms include sudden sharp pain in the back of the leg, often described as a sensation of a “snap” or “pop,” followed by weakness and an inability to walk or stand on tiptoes.
Diagnosis
Clinical diagnosis is based on a history of sudden pain followed by a loss of ankle function. During physical examination, a palpable gap in the tendon is often detected, and the Thompson test is performed, which is positive if there is no plantar flexion when the calf is squeezed. Ultrasound or magnetic resonance imaging (MRI) is useful to confirm the extent of the rupture and plan treatment.
Differential Diagnosis
Condition | Key Differentiation |
|---|---|
Achilles tendinitis | Progressive pain without sudden loss of strength or a “snap,” worsens with physical activity. |
Gastrocnemius muscle tear | Calf pain associated with physical activity, without loss of plantar flexion ability. |
Retrocalcaneal bursitis | Pain and swelling behind the heel, without a palpable tendon defect or significant loss of strength. |
Posterior tibial tendon rupture | Medial ankle pain, with flattening of the foot’s arch, but no involvement of the Achilles tendon. |
Calcaneus fracture | Severe pain following direct trauma, with difficulty walking, confirmed by X-ray. |
Emergency Management
In the emergency department, initial management includes immobilising the foot in a plantar-flexed position (where the tendon is relaxed) to minimise tension on the ruptured tendon. Analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) are administered for pain control.
Immediate referral to an orthopaedic specialist is required, as complete Achilles tendon ruptures typically require surgical treatment. Ultrasound or MRI is recommended to confirm the rupture if the diagnosis is unclear.
Definitive Treatment
Treatment of Achilles tendon rupture depends on the patient’s age, activity level, and the severity of the tear. There are two main options:
Surgical treatment: This involves suturing the ruptured tendon. It is the most common option for younger patients and athletes, as it reduces the risk of re-rupture and allows for quicker functional recovery. After surgery, the leg is immobilised, and an intensive rehabilitation programme is initiated to restore strength and mobility.
Conservative treatment: This involves immobilisation with an orthopaedic boot or cast, keeping the foot in a plantar-flexed position to allow natural healing of the tendon. It is more suitable for older patients or those with lower physical demands, although it carries a higher risk of re-rupture compared to surgery. Rehabilitation is equally crucial to restore full functionality.
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