Makindo Medical Notes.com

This injury is common among athletes and can also occur in non-athletes due to trauma or degenerative changes. Certain antibiotics, such as fluoroquinolones, and corticosteroid injections in the ankle can weaken the tendon and increase the risk of rupture.

About

• May be more subtle than expected
• This is the strongest and thickest tendon in the body
• However can experience a significant force

Aetiology

• Usually seen in athletes or middle-aged occasional sportsman
• Tendon thins with age and rupture is commoner in diabetics, arthritis
• Is increased in those taking quinolones e.g. Ciprofloxacin - inhibits DNA Gyrase
• Steroid injections can weaken the tendon

Clinical

• Feels like a kick or sudden snap in the ankle
• Sometimes it can be less acute and may not initially be recognised
• Patient can still walk flat-footed but cannot run
• There is a palpable depression on palpation and Plantar flexion is weak
• Squeezing the calf does not cause the expected plantar flexion and is painful
• Partial rupture is also possible and presents similarly
• Patients with rupture of the Achilles tendon may still walk.
• Patients with rupture of the Achilles tendon may still actively move the ankle up and down.
• Patients with an Achilles tendon rupture may even manage to stand on tiptoes (on both feet together though not on the injured limb alone).
• Patients with an Achilles tendon rupture will not always have a palpable gap in the tendon

Investigations

• USS:Ultrasound of the tendon
• MRI: can confirm the diagnosis but not always needed and can even mislead

Management

• Non-Surgical:For less active individuals or partial tears, treatment might include rest, ice, compression, and elevation (RICE), along with immobilization in a cast or boot that keeps the foot pointed down (plantar flexion). This allows the tendon to heal naturally over time.
• Surgical:for more active individuals or complete tears. The surgeon typically stitches the torn ends of the tendon back together. Post-surgery, immobilization and physical therapy are required to regain strength and flexibility.
• Rehabilitation:either way physical therapy is crucial to restore strength, flexibility, and function to the Achilles tendon. Recovery can take several months. Athletes may need up to a year to return to their pre-injury levels of activity. Recurrence can be seen.