ACHILLES TENDON RUPTURE

LING CHIENG HAN

1001026517
 Clinical Features
A ripping or popping
sensation is felt, and
often heard, at the back
of the heel.
Sudden severe pain
Unable to stand on the
toes of the affected side.
The typical site for
rupture is about 4 cm
above the tendon
insertion onto the
calcaneum.

https://www.youtube.com/watch?v=YWEGZm_aLEo
 Examination
Plantarflexion of the foot is
usually inhibited and weak
Palpable gap at the site of
rupture
Bruising comes out a day or
two later
The calf squeeze test
(Thompsons or Simmonds
test) is diagnostic of Achilles
tendon rupture
Clinical assessment often
sufficient
Calf Squeeze Test
 A B C

Tendo Achillis
(a) The soleus may tear at its musculotendinous junction (1),
but the tendo Achillis itself ruptures about 5 cm above its insertion (2).
(b) The depression seen in this picture at the site of rupture later fills with blood.
(c) Simmonds test: both calves are being squeezed but only the left foot
plantarflexes the right tendon is ruptured.
Treatment
A plaster cast or special
boot is applied with the
foot in equinus;
Commence
physiotherapy within 4
6 weeks.
A shoe with a raised
heel should be worn for
a further 68 weeks. (A) Patient is seated and foot placed in gravity
equinus.
(B) Below-knee or above-knee cast is placed
with foot in gravity equinus.
 Operative repair
Advantages:
earlier return to function,
better tendon and calf
muscle strength
lower re-rupture rate.
Complications:
wound healing problem
sural nerve neuroma

Krackow technique of double-lock

suture used in the repair of ruptured
Achilles tendon.
FRACTURED METATARSAL
 Mechanism of injury
Crush fracture
Due to direct blow
Spiral fracture
Due to twisting injury
Avulsion fracture
Due to ligament strains
Insufficiency fracture
Due to repetitive stress
 Clinical feature
Pain at foot
Swelling at foot
Bruise at foot
If with stress fracture,
more insidious.
 Radiological feature
AP lateral and oblique view of x-ray of foot
Difficult to detect undisplaced fracture
Stress fracture
Seen only after several weeks later
 Managements

Depend on
Type of fracture
Degree of
displacement
Site of Injury
 Degree of displacement
Undisplaced and minimally
displaced fracture
Support in below-knee cast
or removable boot splint
Elevate foot
Active movements start
immediately
Partial weightbearing for 4
to 6 weeks
 Displaced Fracture
Displacement of 2nd to 5th
metatarsals in coronal plane can be
treated as above.
Elevate foot till swelling
subsides
Traction under anaes
Immobilize leg in cast
Non-weightbearing for 4
weeks
First metatarsal and all fractures
with significant displacement in
sagittal plane
Open reduction and internal
fixation with K-wires or
small screws
Apply below-knee cast
Avoid weightbearing for 3
weeks
Replace another
weightbearing cast for
another 4 weeks
 Fracture of metatarsal neck
Has tendency to displace or
redisplace with closed
immobilization
So check repeatedly if close
treatment is chosen
Maintain unstable position
with percutaneous K-wires
or screw
Wire is removed after 4
weeks
Retain cast immobilization
for 4 to 6 weeks
Fracture of the neck of the 5th metatarsal bone with mild medial displacement.
Frontal and oblique view.
 Fracture of 5th metatarsal base
Also known as Jones
fracture
Forced inversion
Caused by pull exerted by
tendon of peroneus brevis
muscle which inserted on it
Pain, swelling, tenderness at
outer border of foot or base
of 5th metatarsal
Point of tenderness over
prominence at base of 5th
metatarsal bone
 Fracture of 5th metatarsal base
Classification
Proximal
Affect tuberosity
Metaphyseal/diaphyseal
junction
Poor blood supply -----
non-union
Easy to be diagnosed
through x-ray
Treatment
Proximal avulsion
fracture
Initial rest and support
Early mobilization
Intra-articular /
metaphyseal
-diaphyseal junction
High risk of non-union
Interfragmentary screw
screw with plate
Jones Fracture: Frontal and oblique view
Avulsion Fracture of 5th Metatarsal Bone: Oblique and Frontal View
 March fracture
Also known as stress
injury
Usually affect 2nd
metatarsal bone
Young adult
Military recruit or nurse
After overuse, foot
becomes painful n swollen
Palpable lump (distal to
midshaft of metatarsal
bone)
 X-ray
Initially normal
With intense activity shown in radioisotope scan
After 4 to 6 weeks, mass of callus seen
Treatment
Support with elastic bandage
Encourage normal walking

(Left) This x-ray of a patient

who reported pain in the
second metatarsal does not
show an obvious stress
fracture.
(Right) Three weeks later,
an x-ray of same patient
shows callus formation at
the site of the stress
fracture.
 References
Apleys System of Orthopaedics and Fractures,
9th edition
SEMINAR / Academic Activities

Active participation / Performance Date: 27/4/2017

Topic TB Spine, Bone and Joint (TB of Hip and Knee Joint)

No Contents Full marks Marks

awarded
1 Introduction 1 1

2 Content: 5 4
1. Applied anatomy
2. Epidemiology
3. Pathophysiology
4. Clinical features
5. Specific clinical tests
6. Differential diagnosis
7. Investigation
8. Principle of management
9. Rehabilitation
10. Complications

3 Arrangement of presentation 1 1

4 Literature Review/ References 2 1

5 Presentation skill 1 1

Total 10 8

Name of lecturer/Specialist DR. KYIN HTWE