Achilles Tendon Injury

MANUAL MINORS

An Achilles tendon injury is a common injury affecting the strongest and thickest tendon in the body, which connects the calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus). These injuries can range from tendinitis (inflammation of the tendon) to partial or complete ruptures.

They are common in active individuals, especially in sports involving jumping or sudden changes in direction. Symptoms include sudden or progressive pain in the back of the leg, weakness, and, in the case of a complete rupture, an inability to walk or stand on tiptoes.

Diagnosis

Diagnosis is made through clinical history, physical examination, and specific tests such as the Thompson test, where squeezing the calf does not result in plantar flexion if the tendon is ruptured. In less obvious cases, ultrasound or magnetic resonance imaging (MRI) can confirm the extent of the injury.

Differential Diagnosis

Condition	Key Differentiation
Achilles tendinitis	Pain in the back of the leg that worsens with activity but without severe functional loss.
Gastrocnemius muscle tear	Sudden calf pain associated with physical activity, but without an inability to perform plantar flexion.
Retrocalcaneal bursitis	Localised pain behind the heel with visible swelling, without direct involvement of the Achilles tendon.
Posterior tibial tendon rupture	Pain and swelling on the medial side of the ankle, associated with flattening of the foot’s arch.
Calcaneus fracture	Severe pain following direct trauma to the heel, with difficulty walking; confirmed by X-ray.

Emergency Management

Initial management of an Achilles tendon injury in the emergency department involves immobilising the ankle in a plantar-flexed position to minimise tension on the tendon. Analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) are administered for pain control.

If a complete rupture is suspected, immediate referral to an orthopaedic specialist is recommended, as surgical treatment is often required. Ultrasound or MRI is used to confirm the severity of the injury.

Definitive Treatment

Treatment depends on the severity of the injury. Partial ruptures or tendinitis are treated with rest, physiotherapy, and braces that maintain the foot in plantar flexion to allow healing. In complete ruptures, surgical repair is the treatment of choice, involving suturing of the torn tendon.

Postoperative care includes immobilisation and prolonged physiotherapy to restore the function and strength of the tendon. Conservative treatments, such as immobilisation without surgery, may be considered in individuals with lower activity levels, but carry a higher risk of re-rupture.