Essay On Achilles Rupture
Achilles Rupture
Introduction
Although Achilles ruptures are not commonly seen in Primary care a missed diagnosis has significant implications.
What causes Achilles rupture?
The factors leading to rupture of achilles can be divided into two categories:
a) Intrinsic factors- This tendon bears high loads. It is estimated that up to 10 times body weight goes across this tendon when running. In addition it spans three joint (knee, ankle and subtalar joints). There is a zone of relative avascularity, 2-6 cm proximal to its insertion. Most of the Achilles tendon ruptures occour in this region.
b) Extrinsic factors- These include mechanical factors (over pronation), hyperthermia (sudden exposure to increased temperatures, classical example being lack of warm up prior to running or sports), medication (steroids and flouroquinolones) and iatrogenic (steroid injection). (Fig 10.2)
What is the incidence of Achilles ruptures? …show more content…
This however could lead to litigation. There are several reasons for a missed diagnosis. Achilles rupture is usually not associated with significant pain. The patient might not therefore present immediately. Sometimes the patient self diagnoses this as an ankle sprain. I have seen cases where the initial injury happened when the patient was abroad and presented after sometime to their GP. Diagnosing this injury after a while can be challenging due to swelling and hematoma, which can mask the gap. Most common cause of this injury to be missed is due to the fact that the diagnosis of Achilles rupture has not crossed the mind of the examiner. Sometimes the diagnosis might have been considered but as the patient was able to move foot up and down the diagnosis of ruptured Achilles was excluded. Remember that the patient would be able to plantar flex the foot in presence of Achilles rupture as the other plantar flexors (tibialis posterior, flexor digitorum and flexor halluces longus) are
Introduction
Although Achilles ruptures are not commonly seen in Primary care a missed diagnosis has significant implications.
What causes Achilles rupture?
The factors leading to rupture of achilles can be divided into two categories:
a) Intrinsic factors- This tendon bears high loads. It is estimated that up to 10 times body weight goes across this tendon when running. In addition it spans three joint (knee, ankle and subtalar joints). There is a zone of relative avascularity, 2-6 cm proximal to its insertion. Most of the Achilles tendon ruptures occour in this region.
b) Extrinsic factors- These include mechanical factors (over pronation), hyperthermia (sudden exposure to increased temperatures, classical example being lack of warm up prior to running or sports), medication (steroids and flouroquinolones) and iatrogenic (steroid injection). (Fig 10.2)
What is the incidence of Achilles ruptures? …show more content…
This however could lead to litigation. There are several reasons for a missed diagnosis. Achilles rupture is usually not associated with significant pain. The patient might not therefore present immediately. Sometimes the patient self diagnoses this as an ankle sprain. I have seen cases where the initial injury happened when the patient was abroad and presented after sometime to their GP. Diagnosing this injury after a while can be challenging due to swelling and hematoma, which can mask the gap. Most common cause of this injury to be missed is due to the fact that the diagnosis of Achilles rupture has not crossed the mind of the examiner. Sometimes the diagnosis might have been considered but as the patient was able to move foot up and down the diagnosis of ruptured Achilles was excluded. Remember that the patient would be able to plantar flex the foot in presence of Achilles rupture as the other plantar flexors (tibialis posterior, flexor digitorum and flexor halluces longus) are