Transcript Achilles-Rupture-Handoutx

Achilles Rupture
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)
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
Mechanism of Injury
• Traumatic
• Forced ankle dorsiflexion
• Eccentric contraction of Achilles
tendon
• Push off phase of running with
knee extended
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
Objective Examination
• Weakness plantarflexion
• Visible defect of tendon with
swelling
• Loss of resting plantarflexion
• Palpable gap
Special Test
• Thompsons Test
Further Investigation
• US Scan
• MRI
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
Conservative
• Reduce pain, inflammation and protect healing
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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)
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Massage
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
Plan B
• Surgical repair using a variety of different techniques and grafts
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): 245-255.
• 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): 232-235.
• 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.