Foot and Ankle Surgery

Achilles Tendon Rupture

Heel cord rupture

Achilles Tendon Rupture

It has been known since the time of Hippocrates. Incidence of rupture of the achilles tendon rupture is 0.2%, being the most common lower extremity tendon injury.

Etiology

Heel Cord rupture is seen commonly between 30-40 years old. It is 5 times more common in men. Achilles tendon rupture occurs more often in the left side.

Heel cord rupture

,Sedentary individuals and indirect trauma during sporting activity are often observed in the clinical history. Sudden unexpected upward movement of the ankle with powerful calf muscle contraction ( or unnoticed step stroke) may the cause the rupture.

Achilles rupture is more common in the following situations:

Diseases such as Rheumatoid Arthritis, Gout, SLE, renal failure, hypothyroidism, infection, tumors, Quilone group antibiotic usage, corticosteroid treatment are assumed as risk factors for tendon rupture. Achilles tendon related complaint history is positive in  10% of cases.

Patients usually have a feeling that they received a direct blow from behind. A sound can usually be heard by the patient and people nearby

Inability to continue to sports, difficulty in walking, and foot and ankle swelling are the main complaints and findings. Patients report  pain in patients rarely.

Diagnosis

Physical examination is sufficient in the most of the cases. Frequent findings are:

  • Foot and ankle edema
  • a gap felt in the Achilles tendon
  • Thompson Test + (Squeezing of calf muscles do not produce plantar flexion while patient lying in prone position).
  • unable to tiptoe.
  • Radiological evaluation reveals following results:

Direct Radiography is helpful particularly in case of associated calcaneal avulsion fractures, other associated bony injuries

USG / MRI in suspected situations, particularly in partial Achilles ruptures is valuable.

Treatment

Surgery is the treatment in active young people. Conservative treatment is preferred in elder or physically sedanter patients and in partial heel cord ruptures. Below-knee plaster is done as a conservative treatment. Following plaster removal, physical therapy fastens the recovery.

Recently, mini- invazive surgical treatment became popular in the treatment. In this way, patients  recovery times and operative time are shorter. Results are better with surgical Treatment. Early mobilization is encouraged. Surgical treatment lowers the incidence of  the  recurrent tear and loss of plantar flexion strength seen in conservative treatment.

 

 

 

About the author

Prof.Dr. Seref Aktas