Achilles tendon tear

Definition:

A partial or complete discontinuity in the connective tissue fibre matrix comprising the Achilles tendon.

Causes:

The most common cause of Achilles tendon tears result from mechanical stresses. The Achilles tendon is particularly vulnerable at its avascular portion and sports involving stop/start activities such as sprinting, basketball, tennis, and badminton are frequently associated with Achilles tendon tears. Other causes of Achilles tendon tears include inflammatory disorders, autoimmune conditions, neurological pathologies, and pre-determined collagen abnormalities. Corticosteroid therapy, hyperthermia and fluoroquinolones have also been shown to predispose to Achilles tendon tears.

Examination:

Presentation: patients suffering from Achilles tendon tears typically present with a sudden onset of pain in the affected leg, with inability to weight-bare.

Observation: an Achilles tendon tear may present with ecchymoses and oedema over the affected region. In a complete tear of the Achilles tendon, the patient will not be able to plantar-flex the symptomatic foot.
Orthopaedic tests for Achilles tendon tears:

Calf-squeeze test: With thepatient prone on the examining table and the ankles clear ofthe table, the examiner squeezes the triceps surae, resulting in plantarflexion of the ankle if the tendon is intact. The affectedleg should always be compared with the contralateral leg.A false-positive finding may occur in the presence of an intactplantaris tendon.

Knee-flexion test: The patient is asked to actively flex the knees to 90° while lying prone on the examining table. During this movement, if the foot on the affected side falls into neutral or dorsiflexion, a rupture of the Achilles tendon can be suspected