Ankle and foot

Achilles tendon rupture

Mechanism

A sudden eccentric load on an already degenerative tendon, usually on push-off or an unexpected step backwards. Most ruptures sit two to six centimetres above the insertion, where the blood supply is poorest.

Recognition

The patient describes a blow or kick against the calf and can no longer stand on the toes. A palpable gap in the tendon and a positive Thompson test confirm it.

Course

Active plantar flexion often remains possible because the deep calf muscles take over; that is why the diagnosis is missed. The Thompson test bypasses this.

Structures

• Achilles tendon
• Medial head of gastrocnemius
• Soleus

Joints involved

• Ankle joint (talocrural joint)

Clinical tests

• Thompson test

Sources

• Cook J, Rodas G, McCall A, Pruna R, Kennedy R, Til L. Tendon injuries in football players: FC Barcelona 2021 tendon guide. The diagnosis and management of lower limb tendinopathy. FC Barcelona Innovation Hub. Barcelona. 2021
• Magee DJ, Manske RC. Orthopedic Physical Assessment, 7e editie. Elsevier. 2021