Achilles tendon rupture is a significant injury often seen in athletes and physically active individuals, but it can occur in anyone. It involves the complete or partial tear of the Achilles tendon, which connects the calf muscles to the heel bone.
Causes:
- Sudden Increase in Physical Activity: Often occurs in sports involving running, jumping, or rapid changes in direction.
- Inadequate Warm-up: Lack of proper stretching or warm-up before exercise.
- Chronic Tendinopathy: Degeneration of the tendon due to overuse, leading to weakness and increased risk of rupture.
- Steroid Use: Both systemic corticosteroids and local steroid injections can weaken the tendon.
- Certain Medications: Such as fluoroquinolone antibiotics.
- Age-Related Degeneration: More common in middle-aged individuals, particularly those who play sports only occasionally.
Diagnosis:
- History (Hx):
- Mechanism of Injury: Often described as feeling or hearing a sudden “pop” in the heel during physical activity.
- Previous Symptoms: History of calf pain or stiffness which may suggest chronic tendinopathy.
- Medication and Medical History: Including steroid use and systemic diseases like rheumatoid arthritis.
- Physical Examination (Ex):
- Visual Inspection: Swelling, bruising, and possible deformity in the Achilles tendon area.
- Palpation: A gap may be felt in the tendon if it’s a complete rupture.
- Thompson Test: Squeezing the calf muscle while the patient lies prone should cause the foot to flex; failure to do so indicates a rupture.
- Range of Motion and Strength Testing: Reduced strength in plantar flexion.
- Investigations (Ix):
- Ultrasound: Can visualize the tendon and the extent of the rupture.
- MRI: More detailed imaging, useful if surgical repair is considered.
Differential Diagnosis (DDx):
- Partial Achilles Tendon Tear: Less severe injury with some preserved tendon function.
- Achilles Tendinopathy: Chronic degeneration without acute rupture.
- Calf Muscle Strain or Tear: Similar pain but located higher in the calf.
- Bursitis: Inflammation near the heel but without the mechanical deficit of a rupture.
Management (Mx):
- Non-Surgical Treatment:
- RICE Protocol: Rest, Ice, Compression, and Elevation, especially immediately after injury.
- Immobilization: Using a cast, boot, or brace to keep the foot in plantar flexion, allowing the tendon to heal.
- Physical Therapy: After initial immobilization, to restore strength and flexibility.
- Activity Modification: Avoid activities that put stress on the healing tendon.
- Surgical Treatment:
- Indications: Active individuals, athletes, or incomplete healing with conservative management.
- Procedure: Reconnecting and repairing the torn tendon.
- Postoperative Care: Immobilization followed by rehabilitation.
- Rehabilitation:
- Physiotherapy: Gradual exercises to improve strength and range of motion.
- Gradual Return to Activity: Depending on the healing process and under the guidance of a healthcare professional.
- Prevention:
- Adequate Warm-up: Before engaging in physical activity.
- Strengthening and Flexibility Exercises: Especially for the calf muscles.
- Avoid Overtraining: Allowing sufficient rest between intense activities.
Prognosis and Follow-Up: Recovery can take several months, and regular follow-up is important to monitor progress and prevent re-injury. The decision between surgical and non-surgical management depends on the patient’s age, activity level, and the nature of the rupture. Both approaches require a commitment to rehabilitation for optimal recovery.