Achille’s tendon rupture: a review.



The Achilles tendon is a conjoining of the gastrocnemius and soleus muscles, the tendon spans three different joints and is integral in knee flexion, foot plantar flexion, and hindfoot inversion. (2)

Incidence rates of Achilles tendon ruptures varies in the literature, with recent studies reporting a rate of 18 patients per 100,000 patient population annually. In regard to athletic populations, the incidence rate of Achilles tendon injuries ranges from 6% to 18% (1)

Achilles tendon injuries typically occur in individuals who are only active intermittently (i.e., the "weekend warrior" athletes). The injury is reportedly misdiagnosed as an ankle sprain in 20% to 25% of patients. (1)

"Individuals exposed to fluoroquinolones are at increased risk for Achilles tendon rupture, particularly within the first month following exposure to the drug (odds ratios ranged from 1.1 to 7.1)." (3)

Patients may report hearing a pop. Physical exam may show a gap where the tendon rupture has occurred, the patient may have difficulty walking and/or difficulty with plantar flexion. Bruising and pain over the Achilles tendon may also be seen.

The Thompson test should be performed to check the integrity of the Achilles tendon. Thomas test checks for psoas tightness, Obers test checks for IT band tightness, and Patricks test (FABER’s) is used to identify hip/SI pathology.



Achilles tendon rupture usually tends to occur about two to four cm above the calcaneal insertion of the tendon. In individuals who are right-handed, the left Achilles tendon is most likely to rupture and vice versa. (1)

The study compared the sensitivity of physical exam with that of MRI and found that in patients with a positive Thompson’s test, palpable defect, and decreased resting ankle tension, the sensitivity was 100% for predicting a complete tear. (2)

When MRI was utilized, the sensitivity was noted to be 90.9% for the interpretation of a complete tear compared to what was seen intraoperatively. (2)

Thus, the authors recommended MRI not be routinely utilized but reserved for those patients with inconclusive clinical exam findings. (2).

Conclusion: With a surprisingly high potential misdiagnosis rate of 20-25%, it is worth reviewing the physical exam findings associated with Achilles tendon injury.

References:
1: https://www.ncbi.nlm.nih.gov/books/NBK430844/
2: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5344857/
2: https://pubmed.ncbi.nlm.nih.gov/23888427/

Full Review and Conversation on X