■ Tendo Achilles Rupture – Mechanism➣ Sudden contraction also cause Achilles Tendon Rupture, Achilles Tendinitis
➣ Susceptible tendo Achilles are weakened by degenerative disease such as obesity, diabetes, hypertension, and the effects of corticosteroids, all of which lead to vascular compromise

Achilles Tendinitis

Achilles Tendon Rupture

■ Acute rupture: complaints ➣ Stabbing pain in posterior calf
➣ Pts often complain that they were “kicked” in calf
➣ Pain, swelling, decreased or absent push-off

■ Chronic rupture: complaints ➣ Difficulty walking, inability to run, chronic weakness, altered gait, pain and swelling

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Joint Dislocation/subluxation,Complications in joint Dislocation/subluxation

Achilles Tendon Rupture – Physical exam

■ Acute

➣ Palpable defect in posterior calf in area of Achilles tendon

➣ With ecchymosis and swelling
➣ Thompson test

■ Chronic
➣ ± palpable defect of posterior calf
➣ Weakness in pure plantarflexion of foot

■ Classification
➣ Acute ruptures
■ Diagnosis within 0–4 weeks of injury
➣ Chronic ruptures
■ Diagnosis 1–3 months after injury
studies

■ Radiographs
➣ AP, lateral, mortise views (lateral most important)
➣ Radiographs generally normal
➣ Calcifications, traction spurs – Degenerative changes, degenerative changes or partial tear (indicative of longstanding disease
of the tendon)

■ MRI
➣ Generally not necessary for diagnosis of acute ruptures
➣ May be useful in cases of suspected chronic ruptures
➣ Useful in differential diagnosis■
■ Partial tendon tear
■ Localization of tear
■ Gastro soleus tear
■ Plantaris tear

Differential diagnosis
■ Achilles tendinosis
■ Partial tear
■ Avulsion
■ Ankle sprain
■ Isolated plantaris tear
■ Gastro soleus muscle tear

Achilles Tendon Rupture- Treatment

■ Acute
➣ Nonoperative for acute ruptures
■ Cast or brace immobilization (non weight-bearing, 6–8 weeks)
➣ Operative for acute ruptures
■ Open vs. percutaneous repair (Ma procedure)
■ Ma (lower incidence of wound problems)
Lower rate of re rupture with direct repair

■ Chronic
➣ Nonoperative for chronic ruptures
■ AFO or similar bracing (palliative care)
➣ Operative for chronic ruptures
■ Achilles reconstruction using graft (salvage procedure)
■ Flexor hallucis longus

■ Fascial graft

■ Peroneus brevis

➣ Rehabilitation
■ Goals of physical therapy: ROM and strengthening
■ 5–6 months before return to contact sports
■ Role of earlier ROM gaining greater popularity

Disposition
N/A

Prognosis
■ Results of conservative or operative repair generally good (greater
strength with repair)
■ Results of treatment after chronic rupture not as good as with acute

Repair
➣ Reconstruction generally does not allow for return to competitive sports
■ Complications
➣ Rerupture (greater with conservative treatment)
Achilles Tendon Rupture Acromioclavicular Separation 5
➣ Equinus (heel cord tightness)
➣ Skin slough, infection, painful scar
caveats and pearls
■ Careful handling of the soft tissue is imperative to avoid wound
complications.

Joint Dislocation/subluxation, Complications in joint Dislocation/subluxation

Achilles Tendinitis Mechanism, Differential diagnosis, Treatment – (physio-fit-india.com)