- Acute Achilles tendon rupture occurs during ballistic activities or a change in speed.
- The spectrum of injury ranges from minor strain to full tears.
- Patients may complain of sudden severe pain in back of heel.
- The Simmonds’ triad of altered angle of declination (the foot of the injured leg rests in a more dorsiflexed position than the other side when the patient lies prone), palpable gap, and lack of plantarflexion on calf squeeze test will detect a rupture in nearly all cases
- An USS may be indicated to localise and grade pathology however this typically follows specialist assessment.
Conservative measures include
- Avoid activities that exacerbate symptoms
- Patient education
- Shoe wear advice – avoid totally flat, high, or tight shoes. Trainers are appropriate.
- OTC orthotics if flat footed.
Refer immediately to Emergency department if an acute Achilles tendon rupture (full or partial) is suspected. For calf strain,Prescribe PRICE. Avoid HARM for 72 hours following injury. Analgesia – Paracetamol, or a topical NSAID. Consider oral NSAID for 48hr post injury. Start active mobilization after a few days if the person has pain-free use of the muscle in basic movements and the injured muscle can stretch as much as the healthy contralateral muscle. Stretching an eccentric strengthening exercises should commence once the patient is pain free. Consider referral for physiotherapy for strains in athletes, or patients who fail to respond to conservative management. Referral Indications; Any suspicion of achilles rupture. Diagnostic uncertainty, Need for formal physiotherapy, Failure of conservative measures.