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Diagnosis

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Diagnosis of chronic rupture is challenging since by the time patients present to the clinician:

  • the pain and swelling have often subsided
  • the gap between the tendon ends has filled in with fibrous tissue
  • active plantar flexion, although weak, may be possible through the action of the tibialis posterior, flexor hallucis longus, flexor digitorum longus, and peroneal muscles

Hence a high index of suspicion is needed along with other investigations to diagnose the condition (1).

Clinical examination:

  • on inspection there may be
    • a visible gap at the rupture site
    • wasted calf muscles
    • clawing of the toe and higher medial arch of the foot (results due to the accommodation of the long toe flexors for the lack of function of the gastrocnemiussoleus complex)
  • Thompson test (or calf squeeze test), Matles test can be used to detect a ruptured Achilles tendon

Imaging

  • lateral radiographs of the ankle
    • distorted Kager’s triangle (a small fat-filled space between the anterior aspect of the Achilles tendon, the posterior part of the tibia, and the superior aspect of the calcaneus)
    • can rule out other diagnoses such as calcaneal avulsions or other osseous injuries
  • ultrasonography
    • shows tendon discontinuity with decreased or increased echogenicity, depending on the chronicity of the rupture3
  • MRI (1,2)

Reference:


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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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