Contributor: Aaron Lessen, MD

Educational Pearls:

• Achilles tendon rupture usually presents in younger, healthy patients after a sports injury
• Patients typically present complaining of an abrupt onset ankle pain after feeling a "pop"
• • Pain can be localized to posterior ankle and patient's lack the ability to plantarflex
  • Achilles rupture is a clinical diagnosis and does not usually require imaging in the ED
  • Thompson test
  • • Having patient lay on their stomach and squeezing the calf on the injured side should result in plantarflexion
    • If the Achilles is ruptured, no plantarflexion will occur
• Treatment in the ED is to place the patient in a short leg posterior splint with some mild plantarflexion to aid in healing
• After discharge patients should follow up with orthopedics
• Recent study compared those who underwent the traditional open surgery, a minimally invasive surgery, and no surgery
• • No difference in functionality was noted between the groups 3 months to 1 year post injury
  • Those in the nonoperative group had slightly higher rates of repeat rupture (6%) than those in the surgical groups (
  • Patients undergoing minimally invasive surgery had the highest risk of nerve injury (5.2%), followed by traditional surgery (2.8%), and then nonoperative (0.6%)

References

Cuttica DJ, Hyer CF, Berlet GC. Intraoperative value of the thompson test. J Foot Ankle Surg. 2015;54(1):99-101.

Kauwe M. Acute Achilles Tendon Rupture: Clinical Evaluation, Conservative Management, and Early Active Rehabilitation. Clin Podiatr Med Surg. 2017;34(2):229-243.

Myhrvold SB, Brouwer EF, Andresen TKM, et al. Nonoperative or Surgical Treatment of Acute Achilles' Tendon Rupture. N Engl J Med. 2022;386(15):1409-1420.

Summarized by Mark O'Brien, MS4 | Edited by John Spartz MD & Erik Verzemnieks, MD

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