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Early Detection and Management of Achilles Tendon Rupture Important

In this review article, surgeons from the Foot and Ankle Institute in North Carolina offer primary care physicians advice about acute Achilles rupture. Anatomy, cause of injury, and patient presentation are discussed. The authors also offer treatment suggestions including details of possible surgeries.

Achilles ruptures are becoming more common as aging adults remain physically active. Middle-aged men involved in recreational sports are affected most often.

Early treatment is important to avoid future problems, especially re-rupture. Most ruptures occur when the tendon is lengthening from a shortened position. Falls off a ladder or from a height and stepping into a hole are also common causes of Achilles ruptures.

The injury isn't always painful. Most people can still walk with a slight limp. Many cases are misdiagnosed as ankle sprain with a delay in the correct treatment. The Thompson test is the best way to confirm the diagnosis. The patient lies prone (face down) on an exam table. The doctor squeezes just below the widest part of the calf muscle. With a normal Achilles, the foot should point as a result of the test. When the tendon is ruptured, the foot doesn't move.

The authors advise primary care or emergency room doctors to put the leg in a cast or splint. The foot should be pointed slightly to bring the torn ends of the tendon together during healing. Surgery is needed if the gap is too large to close. The authors review the merits and problems of open versus percutaneous (closed) surgical repair.

Surgery is advised for patients who want to return to activity after treatment. Achilles tendon injuries and reinjuries may be prevented through routine calf stretching exercises.

References: Waqqar Khan-Farooqi, MD, and Robert B. Anderson, MD. Achilles Tendon Evaluation and Repair. In The Journal of Musculoskeletal Medicine. May 2006. Vol. 23. No. 5. Pp. 347-358.

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