SEARCH RESULTS FOR: Achilles-Tendon-Rupture

Achilles-Tendon-Rupture

Achilles Tendon Rupture: Pathogenesis and Clinical Findings Achilles tendon ruptures are multifactorial, and may arise from any one or combination of the factors below Authors: Alyssa Federico, Joseph Kendal Reviewers: Davis Maclean, Hannah Koury , Amanda Eslinger, Maninder Longowal, Dave Nicholl, Mehul Gupta, Gerhard Kiefer*, Yan Yu*, Jeremy LaMothe* * MD at time of publication Aging Iatrogenic factors E.g. use of fluoroquinolone antibiotics,or local or systemic corticosteroids Exact mechanisms remain unclear Exercise related factors Vascular compromise Any process that impairs blood flow to the Achilles tendon (e.g. peripheral artery disease) Impaired ability to heal from microtrauma Mechanical factors Abnormal biomechanics: bowleg, flatfoot, excessive supination, obesity, change in terrain Participation in vigorous exercise Excessive heat generation (hyperthermia) in Achilles tendon induces changes in the extracellular matrix Intra-tendinous collagen degeneration, disorientation, and thinningàcompromised Achilles tendon integrity Sudden shear stress and high tension in an already weakened Achilles tendon, stretching it beyond its capacity Haglund’s deformity: enlargement of the calcaneal postero- superior tuberosity Bony enlargement rubs on soft tissue and causes inflammation of Achilles tendon ↓ tendon strength from changes in extracellular matrix Episodic participation or sudden ↑ in exercise Irregular use renders Achilles tendon weaker Microtrauma to the and less flexible Achilles tendon on Achilles Tendon Abnormal loading Sudden, forced dorsiflexion of foot Eccentric contraction of the gastrocnemius-soleus complex The gastrocnemius muscle normally attaches to Achilles tendon to control plantar flexion of the foot With the Achilles tendon ruptured, contraction of the gastrocnemius muscle cannot induce plantar flexion Achilles tendon rupture Achilles tendon innervated by the sural nerve and tibial nerve Pain over rupture site (e.g. “like being kicked in the back of the leg”) Antalgic gate: abnormal gait developed to avoid pain while walking High tension at the origin and insertion points of the tendon causes the ends of the tear to separate The Achilles tendon contains blood vessels. Rupturing the tendon also ruptures the blood vessels withinàblood leaks out into tendon rupture site Bruising and swelling over rupture site ↓ resting ankle plantar flexion (Observed in prone position with knees flexed at 90 degrees) Passive contraction (e.g. squeezing) of the gastrocnemius does not cause plantar flexion + Thompson (calf squeeze) test Weak ankle plantar flexion Lack of push-off in gait Audible “pop” at time of injury Palpable gap between rupture ends Difficulty ambulating ↓ muscle use over time Calf atrophy Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Re-Published March 21, 2021 on www.thecalgaryguide.com