Achilles Rupture
Original Editors - Sam Verhelpen
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Search Strategy[edit | edit source]
Searchwords
- Achilles rupture
- Achilles tendon rupture
- Tendon rupture
- Tendon injuries
- Achilles rupture treatment/physical therapy/physiotherapy
- Achilles tendon rupture treatment/physical therapy/physiotherapy
- Tendon rupture treatment/physical therapy/physiotherapy
- Tendon injuries treatment/physical therapy/physiotherapy
- Achilles tendon incidence
Search databases
- PEDro
- Pubmed
- Web of knowledge
- Medscape
- Google Scholar
Definition/Description[edit | edit source]
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Relevant Anatomical Structures
[edit | edit source]
The Achilles tendon is the insertion of two lower leg muscles, the M. Soleus and the M. Gastrocnemius. These muscles are the main plantar flexors of the ankle. The Achilles tendon is the strongest and longest tendon of our body and connects these muscles to the tuber calcanei[1][2]
Epidemiology /Etiology[edit | edit source]
An injury at the Achilles tendon usually occurs during sports such as badminton[1][3], soccer[3][4], volleyball[3], basketball[5][4], tennis[5][4], raquetball[5], squash[5], with repeated stress on the lower leg muscles. An eccentric movement will put an enormous amount of stress on the tendon. An Achilles tendon rupture occurs more frequently in men than women, with a ratio ranging from 1.7:1 to 12:1 depending on the article[1]. The injury is most common in patients from 30 to 50 years old[6].
Characteristics/Clinical Presentation[edit | edit source]
A complete rupture of the Achilles tendon will show the following characteristics:
- At the moment of rupture a sharp pain will be felt, as if the patient was kicked in the heel[1][6][2][7][4].
- Often the rupture will come with a loud crack or pop[1][4].
- When palpating the tendon, a gap can be felt[1][6][2]. This is not always the case however.
- The back of the heel will be swollen[1][6][2].
- Walking will be nearly impossible[2].
- Standing on the toes will be impossible[2].
- A positive outcome of the calf muscle squeeze test or Thompson’s test[1][6][2][7][4].
- Some patients will have a history of chronic tendonitis in the heel or a prior cortisone injection[1][6][2].
Differential Diagnosis[edit | edit source]
Differential diagnosis includes:
- Acute Achilles tendon peritendinitis[6][4]
- Tennis leg (medial gastrocnemius tear)[6][4]
- Calf muscle strain or rupture[2][4].
- Posterior tibialis stress syndrome[4]
- Ligament injuries[2][4]
- Fracture[6][4]
- Posterior tibialis tendon injuries[4]
- Peroneal injuries[4]
Examination[edit | edit source]
Inspection
- A swollen ankle can point to a rupture of the Achilles tendon.[1][6][2]
- The Achilles tendon is easily palpable. When palpating along the entire length of the tendon, a gap may be present.[4][2] It’s wise to compare to the healthy tendon. Be aware that swelling can mask the gap[1][4]
Active
- One of the first ways to see if a patient has torn his Achilles tendon is de way he or she walks. Plantar flexion is nearly if not totally impossible. So if the patient has a lot of trouble walking, it can be an indication of an Achilles rupture.[1][4][2]
- Instructing the patient to stand on his toes. With an Achilles rupture this will be impossible.[2]
- Ask the patient to actively execute a plantar flexion.[4][2]
- Matles test (knee flexion test).[1][4]
Passive
- Thompson test (calf squeeze test). [1][4][6][2][7]
Medical Management (current best evidence)[edit | edit source]
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Physical Therapy Management (current best evidence)[edit | edit source]
Whether the tendon was treated surgically or non-surgically, the patient’s ankle will be immobilized by a cast for twelve weeks in case of surgery and 6 to 8 weeks when the condition was treated non-surgically.
Physical therapy for an Achilles tendon rupture starts immediately after the cast is removed and is mainly focused around firstly improving the range of motion (ROM) of the ankle, then increasing the muscle strength and muscle coordination[2].
Start off with gentle passive mobilization of the ankle and the subtalar joints. Later go on to active ROM exercises. After two weeks of physiotherapy, progressive resistance exercises are added. Ten weeks after the injury or surgery, start gait training exercises followed by activity specific movements. A return to activities should be expected at 4-6 months of therapy. The rate of rehabilitation greatly depends on the quality of the treatment and the motivation of the patient.[2]
Some examples of exercises that can be given to the patient[5]
At the start of the therapy, 6 to 8 weeks after the surgery, let the patient do:
- Active flexion/extension of the ankle
- Ankle circles (clockwise and counterclockwise)
- Straight leg lifts
- Hip abduction
- Standing hamstringcurl
- Cycling on a stationary bicycle
8 through 12 weeks after the surgery, the patient can start with a theraband exercise program. (start with the theraband with the least resistance and work your way up from there.) The patient should also continue with the previous exercises.
- Ankle eversion and eversion
- Ankle plantar- and dorsiflexion
12 through 24 weeks after the surgery, the first set of exercises can be executed with ankle weights. The following exercises can be added to the training program:
- Calf stretch
- Toe raises
- Single leg balancing
Key Research[edit | edit source]
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Resources
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Clinical Bottom Line[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
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Reference[edit | edit source]
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 Maffulli N. Rupture of the Achilles tendon. J Bone Joint Surg Am. Jul 1999;81(7):1019-36.
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 Jacobs B, MD, FACSM, Lin D, MD, Schwartz E, MD. Achilles Tendon Rupture (2009). fckLRhttp://emedicine.medscape.com/article/85024-overview
- ↑ 3.0 3.1 3.2 Leppilaht J, et al. Incidence of Achilles tendon rupture. Acta Ortbop Scand. 1996; 67 (3): 277-279.
- ↑ 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 4.11 4.12 4.13 4.14 4.15 4.16 4.17 4.18 4.19 Gravlee, J, MD, Hatch, R, MD, MPH. Achilles Tendon Rupture: A Challenging Diagnosis. J Am Board Fam Med. 2000;13(5) © 2000 American Board of Family Medicine.fckLRhttp://www.medscape.com/viewarticle/405807
- ↑ 5.0 5.1 5.2 5.3 5.4 Berkson E. Achilles tendon rupture. Quincy medical center
- ↑ 6.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.09 6.10 Saglimbeni A, MD, Fulmer C, DO. Achilles Tendon Injuries and Tendonitis (2009). fckLRhttp://emedicine.medscape.com/article/309393-overview
- ↑ 7.0 7.1 7.2 Atkinson T, MD, Easley M, MD. Complete Ruptures of the Achilles Tendon (2001). Medscape Orthopaedics & Sports Medicine. 2001;5(3) © 2001 Medscape.fckLRhttp://www.medscape.com/viewarticle/408535
