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You are seeing a 17 year old who was playing basketball for his high school team this evening when he felt a sudden pop and immediate pain in his right Achilles tendon area. He is able to bear weight, but with pain. On exam, there is a palpable gap in his Achilles tendon, and you suspect a ruptured tendon.
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October 8, 2019 at 3:21 pm
D) Patients should be immobilized in slight dorsiflexion, made non-weightbearing, and given early follow-up with an orthopedist.
All of this answer is correct except that the patient should be placed in slight (~ 20 degrees) plantarflexion, to take the stress off the torn Achilles tendon. AT rupture is more common in males, and is associated with sports injuries as well as fluoroquinolone and steroid use, and obesity. Patients typically report a pop, snap, or crack. Up to 25% are missed initially, and the gap can be obliterated by hematoma and scarring, making subsequent diagnosis more difficult. The calf-squeeze or Thompson test is done with the patient in prone position – if the foot plantarflexes with squeezing the calf muscles the test is negative for AT rupture (sensitivity 96%). Ultrasound can also be used to diagnose the rupture. Management is controversial, and can be conservative or surgical. Patients should be referred to an orthopedist early to discuss management options (within a few days).