Medical condition where the tendon at the back of the ankle breaks
Medical condition
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 okay 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 are supporting evidences 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]
^ abcd"Achilles Tendon Tears". MSD Manual Professional Edition. August 2017. Retrieved 26 June 2018.
^ abcdOchen 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.
^ abcdefghijkFerri FF (2015). Ferri's Clinical Advisor 2016 E-Book: 5 Books in 1. Elsevier Health Sciences. p. 19. ISBN 9780323378222.
^ abcEl-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.
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