Achilles Tear

Question 1

ESSENCE

Answer 1

Sudden onset injury resulting in loss of achilles tendon and loss of connection between calf muscles (gastrocnemius and soleus) to the heel (calcaneus bone)

Question 2

AETIOLOGY

Risk factors

Answer 2

• Sports that stress achilles (eg basketball, tennis and track)
• Age
• Existing achilles tedinopathy
• FH
• Fluoroquinolone antibiotics (eg ciprofloxacin and levofloxacin)
• Systemic steroids

Question 3

AETIOLOGY

What drugs are risk factors

Answer 3

• Fluoroquinolone antibiotics
• Systemic steroids

Question 4

CLINICAL FEATURES

Presentation

Answer 4

• Sudden onset of pain in achilles or calf
• A snapping sound and sensation
• Feeling as though something has hit them in back of leg

Question 5

CLINICAL FEATURES

Signs on examination

Answer 5

• When relaxed in dangled position, affected ankle will rest more dorsiflexed position
• Tenderness in area
• Palpable gap in Achilles
• Weakness of plantar flexion
• Unable to stand on tiptoes
• Positive Simmons calf squeeze test

Question 6

Special test

Answer 6

Simmonds calf squeeze test

Question 7

What is simmonds calf squeeze test

Answer 7

• Patient positioned prone or kneeling with feet hanging freely at end of bench
• Squeeze calf muscle in leg with intact Achilles there will be plantar flexion of ankle
• Squeeze affected calf and this will not occur, giving positive result

Question 8

INVESTIGATIONS

First choice

Answer 8

US - makes diagnosis

Question 9

MANAGEMENT

Options

Answer 9

• Immediate management
  
  • Rest and immobilisation
  • Ice
  • Elevation
  • Analgesia
• VTE prophylaxis
• Non-surgical management
• Surgical management

Question 10

MANAGEMENT

Non-surgical

Answer 10

• Specialised boot to immobilise ankle
  
  • First boot full plantar flexion
  • Overtime altered to gradually move ankle from full plantar flexion to neutral
  • Process takes 6-12 weeks

Question 11

MANAGEMENT

Surgical options

Answer 11

• Surgical reattaching Achilles
• After surgery boot is used to immobilise ankle and process like non-surgical management occurs