Injuries of the Ankle

Achilles tendon injury

• the tendon that connects the calf muscle (gastrocnemius) to the heel bone (calcaneus).

• the tendon that is just below the skin at the back of the ankle.

Achilles tendon injury

Side View of Ruptured Achilles' Tendon. Notice depression at

site of rupture (red circle)

Action : -• When the gastrocnemius

muscle (in the calf) contracts (shortens), the tendon which is attached from the muscle to the heel bone (calcaneus) moves.

• As the muscle shortens, the tendon moves to point the foot downwards.

• This is the action that allows a person to stand on one's toes, to run, to jump, to walk normally, and to go up and down stairs.

Diagnosis • History• a sudden snap in the lower calf associated with

acute severe pain• may be able to ambulate with a limp, but he or she

is unable to run, climb stairs, or stand on their toes.

• loss of plantar flexion power in the foot.• swelling of the calf.• history of a recent increase in physical

activity/training.• history of recent use of fluoroquinolones,

corticosteroids, or of corticosteroid injections.• previous rupture of the affected tendon.

Physical examination

– tenderness, – swelling,– ecchymosis, and– tendon defects. – A palpable gap in the Achilles tendon.– unable to stand on the toes on the affected side.

Clinical tests

“Hyperdorsiflexion” sign –– With the patient prone and knees flexed to 90º, maximal

passive dorsiflexion of both feet may reveal excessive dorsiflexion of the affected leg.

Thompson test ––  With the patient prone, squeezing the calf of the

extended leg may demonstrate no passive plantar flexion of the foot if its Achilles tendon is ruptured.

O’Brien needle test – – Insert a needle 10 cm proximal to the calcaneal insertion

of the Achilles tendon. With passive dorsiflexion of the foot, the hub of the needle will tilt when the Achilles tendon is intact.

X – ray of the heel

• Lateral view of the heel

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

Treatment

• Conservative : -

• Immobilising the ankle in slight plantar flexion for 6 to 8 weeks

• Surgery :

• Direct surgical repair and immobilisation in a below – knee plaster cast with slight plantar flexion .

Differential diagnosis

• Achilles tendonitis

• Retrocalcaneal bursitis

• Other ankle injuries

• Ankle osteoarthritis

• Deep vein thrombosis

Complications• Achilles tendon contracture. • Re-rupture. • 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 to 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.