Achilles Tendon Injury

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Background:

• Associated with fluoroquinolone use
• Sudden, severe pain typically with rapid acceleration or pivoting. Sports like football, track and field (sprinting), basketball, soccer
• May hear a "pop"
• Inability to run, stand on toes, or climb stairs
• Most frequently ruptures 2-6cm above calcaneus (where blood supply is weakest)

 
Dx:

• Clinical diagnosis
• Ultrasound can be used in equivocal cases:
  • Use linear probe (high frequency probe)
  • Place probe in longitudinal plane over suspect tendon:
  • Achilles 2-6cm above calcaneus
  • Fan and slide side to side to optimize your view
  • Slide distal to proximal to find defect
  • Turn probe 90° to assess for tendon body defects
  • Positive Findings
    • Discontinuity in longitudinal view of ligament
    • Collection of fluid in longitudinal or transverse view suggests injury
  • Look at other limb for "normal" anatomy
  • Have patient range attempt plantar/dorsi-flexion and view in real time
  • Be aware of partial tears!
• Comparing to normal ankle can reveal smaller defects or tears
  • Kankle
• Thompson test (SN 96% and SP 93%)
  • Lay patient prone with knee bent at 90°
  • In normal patient, squeezing calf results in plantar-flexion; Patient’s with tendon rupture will likely have lack of plantar flexion with calf squeeze
• Palpable defect in Achilles tendon 2-6 cm proximal to calcaneus, however the data on this finding isn’t very strong and wouldn’t base your diagnosis solely on this fact

 
Tx:

• Short leg posterior splint in plantarflexion
• ~25% of ruptures will have some amount of active plantar flexion or be able to walk
• Even if partial tear, splint! Can evolve into a complete tear
• Outpatient orthopedic referral