Achilles Tendon Rupture

Abstract

The onset of Achilles tendon rupture is usually acute, occurring after acute push-off during jumping or sprinting as the result of extreme ankle dorsiflexion. Improper stretching of the gastrocnemius and Achilles tendon before exercise has also been implicated in the development of Achilles tendinitis and acute tendon rupture. The pain of Achilles tendon rupture is constant and severe and is localized in the posterior ankle. The patient often complains of a feeling like being kicked in the ankle. Significant ecchymosis, swelling, and hematoma are frequently present. Palpation of the ruptured Achilles tendon may reveal a lack of tendon continuity. The patient suffering from Achilles tendon rupture exhibits positive results of the toe raise and Thompson squeeze tests. In addition to traumatic rupture of the Achilles tendon, sudden, nontraumatic rupture may occur. Factors that predispose the patient to traumatic and nontraumatic rupture of the Achilles tendon include steroid use, dialysis, gout, rheumatoid arthritis, systemic lupus erythematosus, diabetes, endocrinopathies, renal transplant, hyperlipidemias, and the use of fluoroquinolones.

Keywords

Achilles tendinitis, Achilles tendon, Achilles tendon rupture, ankle pain, sports injury, gout, renal transplant, fluoroquinolones, magnetic resonance testing, diagnostic sonography, ultrasound guided injection, Thompson squeeze test. toe raise test, knee flexion test

ICD-10 CODE M66.369

The Clinical Syndrome

Achilles tendon rupture most often occurs following an injury after acute push-off during jumping or sprinting as the result of extreme ankle dorsiflexion. Occurring in otherwise healthy adults, it is a disease of the third to fifth decades and has a male predominance. Rupture of the Achilles tendon most often occurs in the left leg because right-handed individuals usually push off with the left leg when they jump.

The Achilles tendon is most susceptible to rupture at its narrowest part, a point approximately 5 cm above its insertion. The Achilles tendon is subjected to repetitive motion that may result in microtrauma, which heals poorly owing to the tendon’s avascular nature. The repeated microtrauma leads to tendinitis and tendinopathy that may predispose the tendon to rupture. Achilles tendinitis frequently coexists with bursitis, which causes additional pain and functional disability.

In addition to traumatic rupture of the Achilles tendon, sudden, nontraumatic rupture may occur. Factors that predispose the patient to traumatic and nontraumatic rupture of the Achilles tendon include steroid use, dialysis, gout, rheumatoid arthritis, systemic lupus erythematosus, diabetes, endocrinopathies, renal transplant, hyperlipidemias, and the use of fluoroquinolones ( Box 127.1 ).

Box 127.1

Factors Associated With Rupture of the Achilles Tendon

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Steroid use
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Dialysis
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Gout
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Rheumatoid arthritis
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Systemic lupus erythematosus
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Diabetes
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Endocrinopathies
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Renal transplantation
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Hyperlipidemias
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Fluoroquinolone use

Signs and Symptoms

The onset of Achilles tendon rupture is usually acute, occurring after acute push-off during jumping or sprinting as the result of extreme ankle dorsiflexion. Improper stretching of the gastrocnemius and Achilles tendon before exercise has also been implicated in the development of Achilles tendinitis and acute tendon rupture. The pain of Achilles tendon rupture is constant and severe and is localized in the posterior ankle. The patient often complains of a feeling like being kicked in the ankle. Significant ecchymosis, swelling, and hematoma are frequently present. Palpation of the ruptured Achilles tendon may reveal a lack of tendon continuity. The patient suffering from Achilles tendon rupture exhibits positive results of the toe raise and Thompson squeeze tests ( Fig. 127.1 ). The knee flexion test can also help identify a ruptured Achilles tendon ( Fig. 127.2 ).