Achilles Tendon Rupture Clinical Presentation

  • Author: Brian A Jacobs, MD, FACSM; Chief Editor: Sherwin SW Ho, MD   more...
 
Updated: Dec 13, 2011
 

History

  • Patients with an Achilles tendon rupture frequently present with complaints of a sudden snap in the lower calf associated with acute severe pain.
  • The patient may be able to ambulate with a limp, but he or she is unable to run, climb stairs, or stand on their toes.
  • There is a loss of plantar flexion power in the foot.
  • There may be swelling of the calf.
  • There may be a history of a recent increase in physical activity/training volume.
  • There may be a history of recent use of fluoroquinolones, corticosteroids, or of corticosteroid injections.
  • There may have been a previous rupture of the affected tendon.
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Physical

  • Examine the entire length of the gastrocsoleus-Achilles complex, noting any tenderness, swelling, ecchymosis, and tendon defects. A palpable gap in the Achilles tendon may be appreciated.
  • The patient will be 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 rostrally when the Achilles tendon is intact.[9]
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Causes

The common precipitating event that causes an Achilles tendon rupture is a sudden, eccentric force applied to a dorsiflexed foot.[10, 11, 12] Ruptures of the Achilles tendon also may occur as the result of direct trauma or as the end result following Achilles peritenonitis, with or without tendinosis. Risk factors associated with Achilles tendon rupture include the following:

  • Recreational athlete (weekend warrior)
  • Relatively older age (30-50 y)
  • Previous Achilles tendon injury or rupture
  • Previous tendon injections or fluoroquinolone use
  • Abrupt changes in training, intensity, or activity level
  • Participation in a new activity
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Contributor Information and Disclosures
Author

Brian A Jacobs, MD, FACSM  Consulting Staff, Private Practice, Family Medicine of South Bend; Team Physician, Marian High School

Brian A Jacobs, MD, FACSM is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

David Y Lin, MD  Fellow, Department of Orthopedic Surgery, Section of Pediatrics, University of Tennessee Campbell Clinic

David Y Lin, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Evan Schwartz, MD  Director of Orthopedic Surgery, New York Medical College; Assistant Professor, St John's Queens Hospital, Department of Surgery, Albert Einstein School of Medicine

Evan Schwartz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Society for Sports Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

David T Bernhardt, MD  Director of Adolescent and Sports Medicine Fellowship, Associate Professor, Department of Pediatrics/Ortho and Rehab, Division of Sports Medicine, University of Wisconsin School of Medicine and Public Health

David T Bernhardt, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Sports Medicine, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD  Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and Herodicus Society

Disclosure: Breg, Inc. Consulting fee Consulting; Biomet, Inc. Consulting fee Consulting; GMV, Inc. Arthroscopy Simulator Evaluation and teaching; Smith and Nephew Grant/research funds Fellowship funding; DJ Ortho Grant/research funds Course funding; Athletico Physical Therapy Grant/research funds Course, research funding

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Henry Marano, MD, to the development and writing of this article.

References

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