2.
• often misdiagnosed as an ankle sprain
• may be missed in up to 25%
• Epidemiology
incidence
18:100,000 per year
demographics
more common in men
3. Risk factors
episodic athletes, "weekend warrior"
flouroquinolone antibiotics
steroid injections
Mechanism
usually traumatic injury during a sporting event
may occur with
sudden forced plantar flexion
violent dorsiflexion in a plantar flexed foot
Pathoanatomy
rupture usually occurs 4-6 cm above the calcaneal insertion in hypovascular
region
4. • Anatomy
largest tendon in body
formed by the confluence of
soleus muscle tendon
medial and lateral gastrocnemius
tendons
• blood supply from posterior tibial artery
7. • Physical exam
• inspection
increased resting ankle dorsiflexion in
prone position with knees bent
calf atrophy may be apparent in chronic
cases
• palpation
palpable gap
• motion
weakness to ankle plantar flexion
14. • End-to-end achilles tendon repair
approach
make incision just medial to achilles
tendon to avoid sural nerve
technique
incise paratenon
expose tendon edges
repair with heavy non-absorbable
suture
postoperative care
15.
16. percutaneous achilles tendon repair
concerns over cosmesis of traditional scar
higher risk of sural nerve damage
17. • reconstruction with VY advancement
chronic ruptures with defect < 4cm
– technique
make V cut with apex at
musculotendinous junction with limbs
divergent to exit the tendon undefined
V is incised through only the superficial
18.
19. • flexor hallucis longus transfer +/- VY
advancement of gastrocnemius
chronic ruptures with defect > 4cm
technique
excise degenerative tendon edges
release FHL tendon at the Knot of
Henry and transfer through the calcaneus
20.
21. Complications
• Re-ruptur
generally considered to be higher with
non-operative management (~10-40%
vs 2%
Wound healing complications 5-10%
• Sural nerve injury
higher incidence when percutaneous
approach is used
22. postoperative care
• Traditionally, postoperative rehabilitation
involved wearing a splint with the ankle in
equinus during the immediate
postoperative period. A cast is then placed
within a few days and continued for 6
weeks. The patient is seen in the clinic at
2-week intervals during which the cast is
changed and placed in an increasingly
more dorsiflexed position. After 4 to 6
weeks in the cast, it is advanced to a
23. • A recent trend toward a more functional
rehabilitation program is gaining
popularity. These protocols use an anterior
plaster slab or an orthosis/walking boot
for 6 weeks allowing full range of motion
with the exception of dorsiflexion beyond
neutral.
• The long period of immobilization
increases the likelihood of muscle atrophy,
joint stiffness, cartilage atrophy,
degenerative arthritis, adhesions, and
deep venous thrombosis. In contrast, early
mobilization limits atrophy, promotes fiber
polymerization to collagen, and increases
24.
25. Rehabilitation Program
Following cast removal, gentle passive
range of motion of the ankle and subtalar
joints is initiated.
After 2 weeks, progressive resistance
exercises (PREs) are added to the
regimen.
This is followed by aggressive gait training
exercises at about 10 weeks following the
injury (nonoperative patients) or surgery
(operative patients), leading toward
activity-specific maneuvers and a return to
