eMedicine Specialties > Sports Medicine > Foot and Ankle

Achilles Tendon Rupture: Differential Diagnoses & Workup

Author: Brian A Jacobs, MD, FACSM, Consulting Staff, Private Practice, Family Medicine of South Bend; Team Physician, Marian High School
Coauthor(s): David Y Lin, MD, Fellow, Department of Orthopedic Surgery, Section of Pediatrics, University of Tennessee Campbell Clinic; 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
Contributor Information and Disclosures

Updated: Jun 24, 2009

Differential Diagnoses

Ankle Fracture
Ankle Sprain
Calcaneofibular Ligament Injury
Talofibular Ligament Injury

Other Problems to Be Considered

Achilles tendinosis
Calcaneus bone injuries
Fascial tears
Gastrocnemius/soleus tear (usually a tear of the medial head of the gastrocnemius)
Inflammatory arthropathy
Inflammatory processes
Syndesmosis
Tennis leg (tear of the plantaris tendon)
Vascular injuries

Workup

Laboratory Studies

  • Serum and blood studies are usually unnecessary.

Imaging Studies

  • Radiographs are more useful in ruling out other injuries than in ruling in Achilles tendon ruptures, and they may show findings of soft-tissue swelling, increased ankle dorsiflexion on stress views, vascular or heterotopic calcifications, accessory ossicles, calcaneal fractures, a Haglund deformity, or bony metaplasia.
  • Musculoskeletal ultrasonography can be used to determine the tendon thickness, character, and presence of a tear. This imaging modality is inexpensive, involves no ionizing radiation and, in the hands of skilled ultrasonographers, may be very reliable.
  • Magnetic resonance imaging (MRI) can be used to discern incomplete ruptures from degeneration of the Achilles tendon, and MRI can also distinguish between paratenonitis, tendinosis, and bursitis.

More on Achilles Tendon Rupture

Overview: Achilles Tendon Rupture
Differential Diagnoses & Workup: Achilles Tendon Rupture
Treatment & Medication: Achilles Tendon Rupture
Follow-up: Achilles Tendon Rupture
References
Further Reading
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References

  1. [Best Evidence] Khan RJ, Fick D, Keogh A, et al. Treatment of acute Achilles tendon ruptures. A meta-analysis of randomized, controlled trials. J Bone Joint Surg Am. Oct 2005;87(10):2202-10. [Medline].

  2. Schepsis AA, Jones H, Haas AL. Achilles tendon disorders in athletes. Am J Sports Med. Mar-Apr 2002;30(2):287-305. [Medline].

  3. Keene JS. Tendon injuries of the foot and ankle. In: DeLee JC, Drez D, eds. Orthopaedic Sports Medicine. Philadelphia, Pa: WB Saunders; 1994:1768-1805.

  4. Maffulli N. Rupture of the Achilles tendon. J Bone Joint Surg Am. Jul 1999;81(7):1019-36. [Medline]. [Full Text].

  5. Moore KL. Clinically Oriented Anatomy. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 1999.

  6. Carr AJ, Norris SH. The blood supply of the calcaneal tendon. J Bone Joint Surg Br. Jan 1989;71(1):100-1. [Medline]. [Full Text].

  7. Kader D, Saxena A, Movin T, Maffulli N. Achilles tendinopathy: some aspects of basic science and clinical management. Br J Sports Med. Aug 2002;36(4):239-49. [Medline]. [Full Text].

  8. O'Brien T. The needle test for complete rupture of the Achilles tendon. J Bone Joint Surg Am. Sep 1984;66(7):1099-101. [Medline]. [Full Text].

  9. Saltzman CL, Tearse DS. Achilles tendon injuries. J Am Acad Orthop Surg. Sep-Oct 1998;6(5):316-25. [Medline].

  10. Puddu G, Ippolito E, Postacchini F. A classification of Achilles tendon disease. Am J Sports Med. Jul-Aug 1976;4(4):145-50. [Medline].

  11. Clement DB, Taunton JE, Smart GW. Achilles tendinitis and peritendinitis: etiology and treatment. Am J Sports Med. May-Jun 1984;12(3):179-84. [Medline].

  12. Metz R, Verleisdonk EJ, van der Heijden GJ, et al. Acute Achilles tendon rupture: minimally invasive surgery versus nonoperative treatment with immediate full weightbearing--a randomized controlled trial. Am J Sports Med. Jul 21 2008;epub ahead of print. [Medline].

  13. [Best Evidence] Twaddle BC, Poon P. Early motion for Achilles tendon ruptures: is surgery important? A randomized, prospective study. Am J Sports Med. Dec 2007;35(12):2033-8. [Medline].

  14. Chalmers J. Review article: Treatment of Achilles tendon ruptures. J Orthop Surg (Hong Kong). Jun 2000;8(1):97-99. [Medline]. [Full Text].

  15. Cetti R, Christensen SE, Ejsted R, Jensen NM, Jorgensen U. Operative versus nonoperative treatment of Achilles tendon rupture. A prospective randomized study and review of the literature. Am J Sports Med. Nov-Dec 1993;21(6):791-9. [Medline].

  16. Ma GW, Griffith TG. Percutaneous repair of acute closed ruptured achilles tendon: a new technique. Clin Orthop Relat Res. Oct 1977;128:247-55. [Medline].

  17. Elliot RR, Calder JD. Percutaneous and mini-open repair of acute Achilles tendon rupture. Foot Ankle Clin. Dec 2007;12(4):573-82, vi. [Medline].

  18. DeLee JC, Drez D Jr, Miller MD, eds. Orthopaedic Sports Medicine. 2nd ed. Philadelphia, Pa: WB Saunders; 2003.

  19. [Best Evidence] Pajala A, Kangas J, Siira P, Ohtonen P, Leppilahti J. Augmented compared with nonaugmented surgical repair of a fresh total Achilles tendon rupture. A prospective randomized study. J Bone Joint Surg Am. May 2009;91(5):1092-100. [Medline].

  20. Balasubramaniam P, Prathap K. The effect of injection of hydrocortisone into rabbit calcaneal tendons. J Bone Joint Surg Br. Nov 1972;54(4):729-34. [Medline]. [Full Text].

  21. Bring DK, Reno C, Renstrom P, et al. Joint immobilization reduces the expression of sensory neuropeptide receptors and impairs healing after tendon rupture in a rat model. J Orthop Res. Jul 24 2008;epub ahead of print. [Medline].

  22. Maffulli N, Ajis A. Management of chronic ruptures of the Achilles tendon. J Bone Joint Surg Am. Jun 2008;90(6):1348-60. [Medline]. [Full Text].

  23. Neuhold A, Stiskal M, Kainberger F, Schwaighofer B. Degenerative Achilles tendon disease: assessment by magnetic resonance and ultrasonography. Eur J Radiol. May-Jun 1992;14(3):213-20. [Medline].

  24. Thompson TC, Doherty JH. Spontaneous rupture of tendon of Achilles: a new clinical diagnostic test. J Trauma. 1963;12:126-9.

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Keywords

Achilles tendon rupture, Achilles tendon tear, Achilles tendon injury, Achilles tendon pathology, Achilles injury, Achilles tendon repair, Achilles tendon surgery

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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.

Medical Editor

David T Bernhardt, MD, Director of Adolescent and Sports Medicine Fellowship, Associate Professor, Department of Pediatrics, University of Wisconsin
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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, 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
Sherwin SW Ho, 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.

 
 
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