| Achilles tendon rupture | |
|---|---|
| Other names | Achilles tendon tear,[1] Achilles rupture[2] |
 | |
| The achilles tendon | |
| Specialty | Orthopedics, emergency medicine |
| Symptoms | Pain in the heel[3] |
| Usual onset | Sudden[3] |
| Causes | Forced plantar flexion of the foot, direct trauma, long-standing tendonitis[4] |
| Risk factors | Fluoroquinolones, significant change in exercise, rheumatoid arthritis, gout, corticosteroids[1][5] |
| Diagnostic method | Based on symptoms and examination, supported by medical imaging[5] |
| Differential diagnosis | Achilles tendinitis, ankle sprain, avulsion fracture of the calcaneus[5] |
| Treatment | Casting or surgery[6][5] |
| Frequency | 1 per 10,000 people per year[5] |
Achilles tendon rupture is when the Achilles tendon, at the back of the ankle, breaks.[5] Symptoms include the sudden onset of sharp pain in the heel.[3] A snapping sound may be heard as the tendon breaks and walking becomes difficult.[4]
Rupture typically occurs as a result of a sudden bending up of the foot when the calf muscle is engaged, direct trauma, or long-standing tendonitis.[4][5] Other risk factors include the use of fluoroquinolones, a significant change in exercise, rheumatoid arthritis, gout, or corticosteroid use.[1][5] Diagnosis is typically based on symptoms and examination and supported by medical imaging.[5]
Prevention may include stretching before activity and gradual progression of exercise intensity.[4] Treatment may consist of surgical repair or conservative management.[6][2] Quick return to weight bearing (within 4 weeks) appears acceptable and is often recommended.[6][7] While surgery traditionally results in a small decrease in the risk of re-rupture, the risk of other complications is greater.[2] Non-surgical treatment is an alternative as there is supporting evidence that rerupture rates and satisfactory outcomes are comparable to surgery.[2] If appropriate treatment does not occur within 4 weeks of the injury outcomes are not as good.[8]
Achilles tendon rupture occurs in about 1 per 10,000 people per year.[5] Males are more commonly affected than females.[1] People in their 30s to 50s are most commonly affected.[5]
- ^ a b c d "Achilles Tendon Tears". MSD Manual Professional Edition. August 2017. Retrieved 26 June 2018.
- ^ a b c d Ochen Y, Beks RB, van Heijl M, Hietbrink F, Leenen LP, van der Velde D, et al. (January 2019). "Operative treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review and meta-analysis". BMJ. 364: k5120. doi:10.1136/bmj.k5120. PMC 6322065. PMID 30617123.
- ^ a b c Hubbard MJ, Hildebrand BA, Battafarano MM, Battafarano DF (June 2018). "Common Soft Tissue Musculoskeletal Pain Disorders". Primary Care. 45 (2): 289–303. doi:10.1016/j.pop.2018.02.006. PMID 29759125. S2CID 46886582.
- ^ a b c d Shamrock AG, Varacallo M (January 2018). "Achilles Tendon, Rupture". StatPearls. PMID 28613594.
- ^ a b c d e f g h i j k Ferri FF (2015). Ferri's Clinical Advisor 2016 E-Book: 5 Books in 1. Elsevier Health Sciences. p. 19. ISBN 9780323378222.
- ^ a b c El-Akkawi AI, Joanroy R, Barfod KW, Kallemose T, Kristensen SS, Viberg B (March 2018). "Effect of Early Versus Late Weightbearing in Conservatively Treated Acute Achilles Tendon Rupture: A Meta-Analysis". The Journal of Foot and Ankle Surgery. 57 (2): 346–352. doi:10.1053/j.jfas.2017.06.006. PMID 28974345. S2CID 3506883.
- ^ van der Eng DM, Schepers T, Goslings JC, Schep NW (2012). "Rerupture rate after early weightbearing in operative versus conservative treatment of Achilles tendon ruptures: a meta-analysis". The Journal of Foot and Ankle Surgery. 52 (5): 622–628. doi:10.1053/j.jfas.2013.03.027. PMID 23659914.
- ^ Maffulli N, Ajis A (June 2008). "Management of chronic ruptures of the Achilles tendon". The Journal of Bone and Joint Surgery. American Volume. 90 (6): 1348–1360. doi:10.2106/JBJS.G.01241. PMID 18519331.