Achilles Tendon Rupture

  • Rupture can occur at any age for the GAA athlete, but most often occurs in later stages of a career. This makes the necessity of proper stretching and warm ups particularly important.
  • Rupture can occur with extreme movement, possibly landing wrongly, or strong tackle and this producing a sudden stretch on the tendon.

Diagnosis

The diagnosis may not be obvious initially, and can be missed.

It is important to look actively for features of tendon rupture.

Symptoms

  • Acute onset of pain in the tendon, felt as a sudden, sharp pain initially. Sometimes a 'snap' is heard as the tendon ruptures. The pain then settles into a dull ache.
  • There may also be a history of less intense pain for several days before rupture.
  • Patients may notice an inability to stand on tiptoe, and unable to 'push off' with the affected foot.
Achilles Rupture

Tendonm Examination

  • Observe gait.
  • There is usually localised swelling.
  • There may be an obvious defect in the Achilles tendon (if rupture is complete rather than partial). However, the tendon defect may be masked by bruising.
  • The ability to flex the foot forward and back is weak or absent. (Some flexing may be possible through the action of other muscles.)
  • Thompson's test is performed with the patient lying prone with the knee passively flexed. Absence of normal movement of the foot or toes downward towards the sole on squeezing the calf muscle indicates a complete tendon rupture (compare with the other leg).

Investigations

Ultrasound or MRI may help if the diagnosis is unclear (for example, to distinguish partial rupture from tendonitis).

Management

  • Non-weight bearing as soon as a rupture is suspected.
  • Urgent referral to an orthopaedic specialist for assessment.
  • Treatment options:
    • Surgery may be recommended for inter county athletes and others with a high level of physical activity; if there has been a delay in treatment or diagnosis; and for those with a recurrent rupture. It has lower rates of recurrence. A splint or cast is required after surgery.
    • Conservative management is an option. This consists of rest, pain control and physiotherapy. Crutches are initially required in order to avoid weight bearing.
    • There are different approaches to rehabilitation. With both surgery and conservative treatment, a period of non-weight bearing and a brace or cast will be required. The use of a brace rather than a cast may reduce complications. There seems to be a trend towards earlier weight bearing or early mobilisation using a brace on the ankle which can aid muscle development

Complications

  • Achilles tendon contracture and/or scarring may occur from excessive immobility.
  • Re-rupture can occur. Traditionally, it was found that re-rupture rates were lower with surgery rather than conservative treatment. However, one study found similar rates for both, when patients were also given 'early mobilisation' treatment.

Prognosis

  • Achilles tendon injury has a good prognosis, but the slight loss of function may be very significant for the competitive athlete.
  • Surgical treatment of acute Achilles tendon ruptures significantly reduces the risk of re-rupture compared with non-operative treatment, but has a higher risk of other complications, including wound infection.
  • Athletes may be unable to resume full activities for one year.

 

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