15y/o healthy ♂; was playing soccer; while running backwards, felt a sudden pop a/w immediate onset of severe pain in the left ankle; fell on the ground; wasn’t able to mobilize initially; limping now; no prior similar episodes; no ankle pain prior to this incident; no previous injuries to the Lt ankle; ROS non-contributory;
PMH: non-contributory;
E/O: VSSA;
Lt ankle: mild posterior swelling and ecchymosis; no erythema; no atrophy; tenderness over Achilles tendon with a palpable gap 4cm above its calcaneal insertion; Thompson’s test +ve;
I/P: Achilles tendon rupture; NSAIDs; RICE; urgent ortho consult;
Discussion(1-2):
>75% occur in 30-40 yr olds; Male/Female=10/1; usually happens 30-40min after the start of the activity; Patients feel as if “I was kicked in the back of the leg” a/w a painful snap;
Total rupture: Thompson’s/Simmonds’ calf squeeze test +ve; “Hatchet strike” defect (palpable, tender defect 3-6cm proximal to the calcaneal insertion) may be present in the immediate post rupture period; not palpable after a few days due to swelling; Only 25% of the tendon fibers are needed for normal Achilles tendon function, hence the difficulty in Dx of partial tears; Weak or absent active dorsiflexion;
NSAIDs prn; RICE; ortho consult; surgical vs conservative management; needs careful patient selection; recent trend toward conservative Rx with early ROM (cast for 2wk then functional brace); conservative Rx earlier return to function; surgery less re-rupture at 1-4% (conservative at 10-30%), but ↑complications (infection, DVT & PE, adhesions);
References:
2. Brukner, P., Brukner, P., D.R.C.O.G, & Khan, K. (2009). Clinical sports medicine. North Ryde, N.S.W: McGraw-Hill.
