ACHILLES TENDON

RUPTURE
DEFENITION
The achilles tendon is the
strongest and largest
tendon in the human body
which is 15 cm long,
starting from the middle of
the lower leg and the
structure is attached to the
middle - back of the
calcaneus bone. The achilles
tendon originates from a
combination of 3 muscles
namely gastrocnemius,
soleus, and plantaris
Cont'
Achilles tendon rupture is
a rupture or rupture of a
tendon (connective
tissue) connection
caused by injury from
sudden or sudden
positional changes in a
state of maximal passive
dorsiflexion.
EPIDEMIOLOGY
• The actual frequency of achilles tendon rupture is
unknown, but historically this injury is considered a
rare occurrence.
• There have been less than 0.2% of the population
and have continued to increase in the last decade.
• The average age is 30-40 years,
• 20: 1 in men and women.
• The incidence of achilles tendon rupture increases
up to 50% in developed countries.
ETIOLOGY
• Certain diseases such as arthritis and diabetes
• Medications, such as corticosteroids and
fluoroquinolone (ciprofloxacin) antibiotics
• Injury in sports
• Sharp / blunt force trauma
• Obesity
RUPTURE MECHANISM
• The first mechanism, the patient puss-off by
leaning on the legs while the knees are stretched.
This mechanism occurs in most patients. This
mechanism occurs during sprints, jumping and
racquet sports.
• The second mechanism in the dorsiflexion of the
ankle is sudden and unexpected, for example when
the patient slips into a hole or falls down the stairs.
• The third mechanism is dorsiflexion of plantar-
flexion legs that occurs when falling from a height
CLASSIFICATION
Based on the severity and degree of retraks, achilles
tendon rupture is divided into 4 types:
• Type I partial rupture is less than equal to 50%
• Type II complete rupture with a tendon gap of less
than 3 cm.
• Type III complex rupture with 3-6 cm tendon gap.
• Type IV complete rupture with defects greater than
6 cm (neglected rupture).
CLINICAL MANIFESTATIONS
• Sudden, severe pain is felt at the back of the ankle.
• It looks swollen and stiff and looks bruised
• Weakness
• Depression is seen in tendons 3-5 cm above the
heel
• The heel cannot be moved up and down
DIAGNOSIS
1. Physical Examination
Perform general foot and ankle examinations: check
posterior ankles, palpable swelling in tendons, check
muscle strength.
• Plantar flexion of the feet is usually obstructed and
weak.
• Usually felt the distance in the area of rupture
• Bluish appear one to two days later.
Thompson Test
The patient is
supine and the
examiner squeezes
the injured calf
muscle. If the
tendon is intact, the
foot will be plantar-
flexed, but if the
tendon ruptures
there will be
minimal or no
reaction in the leg
and the test is said
Mantles Test
• In the Mantles test,
the patient is told to
reflect both knees and
changes in foot
position are observed.
This test is positive if
the leg on the injured
side moves neutral or
dorsiflexion.
Support Examination
• X-ray: to analyze the point of injury
• Ultrasound: to determine tendon thickness
• MRI: to show in detail the tips of ruptured tendons
MANAGEMENT
1. Operation
Surgery can be performed, in which the severed end
of the tendon is reconnected by suturing technique.
Surgery is considered the most effective in the
management of the severed tendon.
2. Non-operation
Namely with orthotics or physical therapy. Usually
done for non-athletes because of long recovery or in
patients who refuse to do surgery.
COMPLICATION
• Repeated rupture and decreased flexion ability of
the plantar
• Superficial skin infections,
• Deep infections,
• Heel ulcers,
• Partial or complete achilles re-rupture
PROGNOSIS
• With proper care and rehabilitation, the prognosis
of achilles tendon rupture is good to perfect.