Achilles tendon rupture

Achilles tendon rupture commonly occurs as an acceleration injury e.g. pushing off or jumping up. Diagnosis is made by clinical history; typically people say it feels like being kicked or shot behind the ankle, and by examination, when a gap may be felt in the tendon, and Simmonds' test is positive.

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The Thompson test or Simmonds' test is where on squeezing the calf of the affected side, no movement (no passive planter flextion) is elicited in the foot, which would normally be expected to move. Sometimes an ultrasound scan may be required to confirm the diagnosis. MRI can also be used to confirm the diagnosis.

An O'Brien's test can also be performed which entails placing needles into the tendon. If the needle hub moves in the opposite direction of the tendon and the same direction as the toes when the foot is moved up and down then the tendon is intact.

Treatment remains divided between operative and non-operative management. Non-operative management consists of restriction in an "equinus" plaster cast for eight weeks with the foot pointed downwards (to oppose the ends of the ruptured tendon). Some surgeons feel an early surgical repair of the tendon is beneficial. The surgical option offers a significantly ([5% vs 40%]) smaller risk of re-rupture, but has the attendant risks of surgery i.e. infection, bleeding etc.

Most cases of Achilles tendon rupture are traumatic (caused by injury). The average age of patients is 30-40 years with a male-to-female ratio of nearly 20:1. Fluoroquinolone antibiotics, such as ciprofloxacin, and glucocorticoids have been linked with an increased risk of Achilles Tendon rupture. Direct steroid injections into the tendon have also been linked to rupture.