Achilles Tendon Rupture

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

An Achilles tendon rupture is a complete or partial tear of the Achilles tendon, which connects the calf muscles to the heel bone. This injury often occurs suddenly during activities that involve forceful plantarflexion of the foot, such as jumping or sprinting.

Aetiology

Achilles tendon ruptures are caused by:

• Sudden, forceful movements such as jumping or pushing off the foot
• Rapid acceleration or deceleration, particularly in sports
• Pre-existing Achilles tendinopathy or degenerative changes in the tendon
• Direct trauma to the tendon

Pathophysiology

The pathophysiology of Achilles tendon rupture involves:

• Overloading of the tendon beyond its tensile strength, leading to a tear
• Degenerative changes within the tendon, often associated with chronic tendinopathy, which weaken the tendon and make it more susceptible to rupture
• Inflammation and haemorrhage at the site of the rupture, leading to pain, swelling, and loss of function

Risk Factors

• Participation in sports, particularly those involving running, jumping, or sudden changes in direction (e.g., basketball, football, tennis)
• Middle age (the condition is most common in people aged 30-50 years)
• Previous Achilles tendon injuries or tendinopathy
• Inadequate warm-up or stretching before exercise
• Use of certain medications, such as corticosteroids or fluoroquinolone antibiotics, which can weaken tendons
• Sudden increases in physical activity or intensity

Signs and Symptoms

The signs and symptoms of an Achilles tendon rupture include:

• A sudden, sharp pain at the back of the ankle or calf, often described as feeling like being kicked or hit
• An audible "pop" or snapping sound at the time of injury
• Swelling and bruising around the Achilles tendon
• Inability to bear weight on the affected leg
• Difficulty or inability to point the foot downward (plantarflexion)
• A palpable gap or defect in the tendon, typically located 2-6 cm above the heel

Investigations

Specific investigations to diagnose an Achilles tendon rupture include:

• Clinical examination: Physical assessment, including the Thompson test (squeezing the calf while the patient is lying prone to observe plantarflexion).
• Imaging studies:
  • Ultrasound: To assess the extent of the rupture and confirm the diagnosis.
  • MRI: Used in cases where the diagnosis is unclear or to plan surgical repair.

Management

Primary Care Management

• Initial assessment and immobilisation: Immediate referral to orthopaedics or an emergency department is required.
• Pain management: Analgesics such as paracetamol or NSAIDs to relieve pain.
• Rest and immobilisation: The ankle should be immobilised in a splint or cast in a slightly plantarflexed position to allow healing.

Specialist Management

• Surgical repair: Often recommended for younger or more active patients, surgery involves suturing the torn ends of the tendon together.
• Non-surgical management: Involves prolonged immobilisation in a cast or boot, followed by a structured rehabilitation programme. This approach may be preferred for older or less active patients.
• Rehabilitation: Physiotherapy is crucial post-treatment, whether surgical or non-surgical, to restore strength, flexibility, and function.

References

1. NHS (2024) Achilles Tendon Rupture. Available at: https://www.nhs.uk/conditions/achilles-tendon-rupture/ (Accessed: 24 June 2024).
2. National Institute for Health and Care Excellence (2024) Achilles Tendon Rupture. Available at: https://cks.nice.org.uk/topics/achilles-tendon-rupture/ (Accessed: 24 June 2024).
3. British Medical Journal (2024) Achilles Tendon Rupture: Clinical Features, Diagnosis, and Management. Available at: https://www.bmj.com/content/350/bmj.h2889 (Accessed: 24 June 2024).
4. American Academy of Orthopaedic Surgeons (2024) Achilles Tendon Rupture. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/achilles-tendon-rupture/ (Accessed: 24 June 2024).

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