1. Achilles Rupture

2. Normal Anatomy Origin- the mid calf
Insertion – posterior aspect of calcaneus
Made up of soleus AND gastrocnemius
Made from water (approximately 80%) collagen, ground substance and elastin
Large amount of Type I Collagen in an organised structure
Type 1 collagen provides good tensile strength (pulling force)

3. Pathology Tear of the Achilles tendon Degenerative Theory
Tendon structure changes
Increase in elastin
Decreases tensile strength
Mechanical Theory
Violent muscle contraction
Exceeds the limit of the tendon

4. Mechanism of Injury Traumatic Forced ankle dorsiflexion
Eccentric contraction of Achilles tendon
Push off phase of running with knee extended

5. Subjective Examination
Sporting history with sudden starting and stopping (tennis, basketball, badminton)
Traumatic dorsiflexion or eccentric contraction
Traumatic push off phase of running
Sensation of being kicking or shot in back of heel
Popping sensation or sound
Inability to weight bear
Push off during walking absent
Initially painful which may subside over a period of time

6. Objective Examination
Weakness plantarflexion
Visible defect of tendon with swelling
Loss of resting plantarflexion
Palpable gap

7. Special Test
Thompsons Test

8. Further Investigation
US Scan
MRI

9. Management
Conservative management considered in those less active or high risk factors for infection following surgery
Ideally started ASAP following rupture
Overall rehab programme approximately 7 – 8 months
Rehab programmes for conservative and non-conservative management consultant led
See (Thevendran, Sarraf et al. 2013) for more details

10. Conservative Reduce pain, inflammation and protect healing
Equinius cast to allow healing of the tendon for approximately 4 weeks then removable brace for 2 weeks
NSAID’s
Ice
Massage
Restore Normal Range of Movement
Knee, Hip (avoid stretching the calf)
Joint mobilisations
Joint manipulations
stretches
Restore Normal Muscle Activation
Isometrics in pain free range
Maintain strength of knee, hip, lumbopelvic spine
Restore Dynamic Stability (once normal ROM achieved)
Proprioceptive training
Sport specific training

11. Plan B
Surgical repair using a variety of different techniques and grafts

12. References
Barfod, K. W. (2014). "Achilles tendon rupture; assessment of nonoperative treatment." Dan Med J 61(4): B4837.
Freedman, B. R., J. A. Gordon and L. J. Soslowsky (2014). "The Achilles tendon: fundamental properties and mechanisms governing healing." Muscles Ligaments Tendons J 4(2):
Gulati, V., M. Jaggard, S. S. Al-Nammari, C. Uzoigwe, P. Gulati, N. Ismail, C. Gibbons and C. Gupte (2015). "Management of achilles tendon injury: A current concepts systematic review." World Journal of Orthopedics 6(4).
Stavrou, M., A. Seraphim, N. Al-Hadithy and S. C. Mordecai (2013). "Review article: Treatment for Achilles tendon ruptures in athletes." J Orthop Surg (Hong Kong) 21(2):
Thevendran, G., K. M. Sarraf, N. K. Patel, A. Sadri and P. Rosenfeld (2013). "The ruptured Achilles tendon: a current overview from biology of rupture to treatment." Musculoskelet Surg 97(1): 9-20.