Materiały źródłowe

• #1 Achilles Tendon Rupture – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430844/

  Achilles tendon rupture is the most common tendon rupture in the lower extremity. Acute ruptures often present with sudden onset of pain associated with a „snapping” or audible „pop” heard at the injury site. Patients may describe a sensation similar to being kicked in the lower leg. […] The clinical diagnostic criteria for evaluating Achilles tendon ruptures are more sensitive than MRI studies. In addition, MRI studies can be expensive, time-consuming, and delay surgical treatment. For these reasons, MRI should only be obtained in ambiguous presentations and subacute or chronic injuries for preoperative planning. […] Following a thorough history and physical exam, the physician should determine whether the patient sustained an Achilles rupture, particularly when a positive Thompson test is 96% to 100% sensitive and 93% to 100% specific. […] Imaging tests, such as plain radiograph, MRI, or ultrasound, may be ordered to rule out other injuries and confirm the diagnosis of Achilles tendon rupture. […] Nevertheless, as previously mentioned, over 20% of Achilles tendon ruptures are misdiagnosed.

• #2 Achilles tendon rupture – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/achilles-tendon-rupture/

  Diagnosis is clinical and may be confirmed on ultrasound or MRI. […] Clinical diagnosis of Achilles tendon rupture is based on 2 of the following examination findings: Abnormal Thompson test, Abnormal Matles test, Decreased plantar flexion strength, Palpable Achilles tendon gap. […] More than 20% of acute Achilles tendon ruptures are missed and subsequently become chronic ruptures. […] Consider imaging to confirm the diagnosis and/or exclude other suspected pathologies (e.g., fracture). […] Initial testing: x-ray, mainly used to exclude suspected fractures. […] Confirmatory studies: ultrasound and/or MRI can distinguish partial- and full-thickness tears.

• #3 :: CIOS :: Clinics in Orthopedic Surgery

  https://ecios.org/DOIx.php?id=10.4055/cios.2020.12.1.1

  The diagnosis of acute Achilles tendon rupture is mostly based on a thorough history taking and physical examination. Typical patients are in their third or fourth decade of life and present with sudden inability to walk and acute pain during running or jumping. Patients with an acute rupture of the tendon often describe that they heard a popping sound in the back of the leg in dorsiflexion of the ankle or had the feeling of being kicked in the back of the ankle. Signs of a ruptured tendon include plantar flexion weakness, difficulty with weight-bearing ambulation, and limping. A false-negative Thompson test result can occur if plantar flexion is produced by intact extrinsic foot flexors; approximately 25% of acute ruptures are initially neglected for this reason. According to the American Academy of Orthopaedic Surgeons clinical practice guidelines, the diagnosis of an acute Achilles tendon rupture can be established by two or more of the following physical examination tests: (1) a positive Thompson test, (2) decreased plantar flexion strength, (3) presence of a palpable defect, and (4) increased passive ankle dorsiflexion with gentle manipulation. During diagnosis, it is important to differentiate traumatic sports injuries from low-energy injuries. The diagnosis of acute Achilles tendon rupture is primarily clinical, supported by imaging tests. Magnetic resonance imaging (MRI) or ultrasonography can be useful as a confirmatory test. Since MRI is not a dynamic imaging modality, it is not reliable in adequately determining partial or complete rupture. By contrast, ultrasonography is more effective in identifying the location of a tear, gap between the torn ends of the tendon, and partial/complete rupture. Plain radiography (lateral views of the ankle) is used in treatment planning. It also aids in identification of tendon swelling and increased soft tissue density in the Kager’s fat pad. Above all, it is superior to other imaging modalities in detecting presence of a calcific lesion, Haglund prominence, or calcaneus avulsion fracture, suggestive of preexisting degeneration or chronic tendinosis. In the case of a rupture in chronic Achilles tendinopathy, the risk of rerupture is high after either conservative treatment or direct repair. Direct healing of the pathologic tissue at the ruptured ends is oftentimes not feasible in this case. Then, the surgeon should consider other treatment options using healthy tissue, such as tendon reconstruction. Therefore, it is of utmost importance to confirm the presence or absence of pre-existing tendinopathy for differential diagnosis of acute Achilles tendon rupture. Plain radiography is a more appropriate than MRI or ultrasonography for this purpose.

• #4 Diagnosing Achilles Injury | NYU Langone Health

  https://nyulangone.org/conditions/achilles-injury/diagnosis

  NYU Langone doctors use a physical exam and advanced imaging tests to diagnose injury to the Achilles tendon, including Achilles tendinitis and Achilles rupture. […] Our doctors conduct a physical exam and imaging tests to determine whether you have injured your Achilles. […] He or she may also assess your range of motion by asking you to walk or by using whats called a Thompson test. For this test, you lie face down on an exam table with your feet off the end. The doctor squeezes your calf muscle. If this action does not cause the toes to point downward, the Achilles tendon is likely ruptured. […] An MRI scan, which creates images of soft tissues in the body, including muscles and tendons, can help your doctor determine whether you have a partial or complete rupture and find its precise location along the tendon.

• #5 Achilles Tendon Rupture – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430844/

  Achilles tendon rupture is the most common tendon rupture in the lower extremity. Acute ruptures often present with sudden onset of pain associated with a „snapping” or audible „pop” heard at the injury site. Patients may describe a sensation similar to being kicked in the lower leg. […] The clinical diagnostic criteria for evaluating Achilles tendon ruptures are more sensitive than MRI studies. In addition, MRI studies can be expensive, time-consuming, and delay surgical treatment. For these reasons, MRI should only be obtained in ambiguous presentations and subacute or chronic injuries for preoperative planning. […] Following a thorough history and physical exam, the physician should determine whether the patient sustained an Achilles rupture, particularly when a positive Thompson test is 96% to 100% sensitive and 93% to 100% specific. […] Imaging tests, such as plain radiograph, MRI, or ultrasound, may be ordered to rule out other injuries and confirm the diagnosis of Achilles tendon rupture. […] Nevertheless, as previously mentioned, over 20% of Achilles tendon ruptures are misdiagnosed.

• #6 Achilles Tendon Tears – Injuries; Poisoning – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/injuries-poisoning/sprains-and-other-soft-tissue-injuries/achilles-tendon-tears

  Achilles tendon tears (ruptures) most often result from ankle dorsiflexion, particularly when the tendon is taut. Diagnosis is by examination and sometimes MRI. […] Diagnosis of Achilles tendon tears is clinical. The patient’s ability to flex the ankle does not rule out a tear. […] If clinicians suspect an Achilles tendon tear, 3 main tests can be done to help confirm the diagnosis. […] Physical examination is more sensitive than MRI for detecting a Achilles tendon tear. A study of patients with an Achilles tendon tear (2012) found that if all 3 tests (Thompson, Matles, palpation of the gap) are positive, sensitivity for an Achilles tear is 100%. According to the American Academy of Orthopedic Surgeons guidelines (2009), diagnosis of a tear requires only one of the following: 2 of these 3 tests are positive or 1 of the tests is positive and ankle plantar flexion is weakened. […] Ultrasonography is being increasingly used to confirm tendon tears or to differentiate between partial and complete tears when imaging is required. Diagnostic accuracy appears to be good when done by experienced operators.

• #7 Achilles Tendon Rupture: Causes, Symptoms, Test, Treatment

  https://www.medicinenet.com/achilles_tendon_rupture/article.htm

  Patients with an Achilles tendon rupture will often complain of a sudden snap in the back of the leg. The pain is often intense and patients will describe it as if being shot. […] A healthcare professional makes a diagnosis of Achilles tendon rupture by taking a patient’s history and performing a physical exam as noted above. Imaging may be required to confirm the extent of tendon damage and to look for other associated injuries. […] The Thompson test helps confirm the diagnosis: The patient lies prone, face-down. The examiner squeezes the calf area. With an intact Achilles tendon, the foot will plantar flex and the toes point downward. With Achilles tendon rupture, the foot does not move. […] Plain X-rays of the foot may reveal swelling of the soft tissues around the ankle, other bone injury, or tendon calcification.

• #8 Achilles Tendon Rupture: Diagnosis & Treatment | Mass General Brigham

  https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/sports-medicine/conditions/foot-ankle/achilles-tendon-rupture/treatment

  Once your doctor has performed any necessary exams and imaging, they’ll assign your Achilles tendon rupture a grade from 1 to 3: Grade 1: A mild injury that brings minimal torn tendon fibers, known as a partially torn Achilles, Grade 2: A moderate injury with less than half the Achilles tendon fibers tearing, Grade 3: The most severe form of Achilles tendon injury, a rupture in which the majority or all the fibers tear. […] The red flags for Achilles tendon rupture are: A popping sound at the moment of injury, A feeling like you’ve been kicked in the calf, Swelling, bruising, and pain at the back of the ankle, especially during athletic activities like walking, running, and jumping, Swelling and thickening of the tendon, Instability and difficulty walking, especially on an incline or decline.

• #9 Achilles Tendon Rupture: Diagnosis & Treatment | Mass General Brigham

  https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/sports-medicine/conditions/foot-ankle/achilles-tendon-rupture/treatment

  Once your doctor has performed any necessary exams and imaging, they’ll assign your Achilles tendon rupture a grade from 1 to 3: Grade 1: A mild injury that brings minimal torn tendon fibers, known as a partially torn Achilles, Grade 2: A moderate injury with less than half the Achilles tendon fibers tearing, Grade 3: The most severe form of Achilles tendon injury, a rupture in which the majority or all the fibers tear. […] The red flags for Achilles tendon rupture are: A popping sound at the moment of injury, A feeling like you’ve been kicked in the calf, Swelling, bruising, and pain at the back of the ankle, especially during athletic activities like walking, running, and jumping, Swelling and thickening of the tendon, Instability and difficulty walking, especially on an incline or decline.

• #10 :: CIOS :: Clinics in Orthopedic Surgery

  https://ecios.org/DOIx.php?id=10.4055/cios.2020.12.1.1

  The diagnosis of acute Achilles tendon rupture is mostly based on a thorough history taking and physical examination. Typical patients are in their third or fourth decade of life and present with sudden inability to walk and acute pain during running or jumping. Patients with an acute rupture of the tendon often describe that they heard a popping sound in the back of the leg in dorsiflexion of the ankle or had the feeling of being kicked in the back of the ankle. Signs of a ruptured tendon include plantar flexion weakness, difficulty with weight-bearing ambulation, and limping. A false-negative Thompson test result can occur if plantar flexion is produced by intact extrinsic foot flexors; approximately 25% of acute ruptures are initially neglected for this reason. According to the American Academy of Orthopaedic Surgeons clinical practice guidelines, the diagnosis of an acute Achilles tendon rupture can be established by two or more of the following physical examination tests: (1) a positive Thompson test, (2) decreased plantar flexion strength, (3) presence of a palpable defect, and (4) increased passive ankle dorsiflexion with gentle manipulation. During diagnosis, it is important to differentiate traumatic sports injuries from low-energy injuries. The diagnosis of acute Achilles tendon rupture is primarily clinical, supported by imaging tests. Magnetic resonance imaging (MRI) or ultrasonography can be useful as a confirmatory test. Since MRI is not a dynamic imaging modality, it is not reliable in adequately determining partial or complete rupture. By contrast, ultrasonography is more effective in identifying the location of a tear, gap between the torn ends of the tendon, and partial/complete rupture. Plain radiography (lateral views of the ankle) is used in treatment planning. It also aids in identification of tendon swelling and increased soft tissue density in the Kager’s fat pad. Above all, it is superior to other imaging modalities in detecting presence of a calcific lesion, Haglund prominence, or calcaneus avulsion fracture, suggestive of preexisting degeneration or chronic tendinosis. In the case of a rupture in chronic Achilles tendinopathy, the risk of rerupture is high after either conservative treatment or direct repair. Direct healing of the pathologic tissue at the ruptured ends is oftentimes not feasible in this case. Then, the surgeon should consider other treatment options using healthy tissue, such as tendon reconstruction. Therefore, it is of utmost importance to confirm the presence or absence of pre-existing tendinopathy for differential diagnosis of acute Achilles tendon rupture. Plain radiography is a more appropriate than MRI or ultrasonography for this purpose.

• #11 Achilles Tendon Rupture: Diagnosis & Treatment | Mass General Brigham

  https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/sports-medicine/conditions/foot-ankle/achilles-tendon-rupture/treatment

  Once your doctor has performed any necessary exams and imaging, they’ll assign your Achilles tendon rupture a grade from 1 to 3: Grade 1: A mild injury that brings minimal torn tendon fibers, known as a partially torn Achilles, Grade 2: A moderate injury with less than half the Achilles tendon fibers tearing, Grade 3: The most severe form of Achilles tendon injury, a rupture in which the majority or all the fibers tear. […] The red flags for Achilles tendon rupture are: A popping sound at the moment of injury, A feeling like you’ve been kicked in the calf, Swelling, bruising, and pain at the back of the ankle, especially during athletic activities like walking, running, and jumping, Swelling and thickening of the tendon, Instability and difficulty walking, especially on an incline or decline.

• #12 Achilles Tendon Rupture: Diagnosis & Treatment | Mass General Brigham

  https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/sports-medicine/conditions/foot-ankle/achilles-tendon-rupture/treatment

  Once your doctor has performed any necessary exams and imaging, they’ll assign your Achilles tendon rupture a grade from 1 to 3: Grade 1: A mild injury that brings minimal torn tendon fibers, known as a partially torn Achilles, Grade 2: A moderate injury with less than half the Achilles tendon fibers tearing, Grade 3: The most severe form of Achilles tendon injury, a rupture in which the majority or all the fibers tear. […] The red flags for Achilles tendon rupture are: A popping sound at the moment of injury, A feeling like you’ve been kicked in the calf, Swelling, bruising, and pain at the back of the ankle, especially during athletic activities like walking, running, and jumping, Swelling and thickening of the tendon, Instability and difficulty walking, especially on an incline or decline.

• #13 Achilles tendon rupture: how to avoid missing the diagnosis | British Journal of General Practice

  https://bjgp.org/content/65/641/668

  Over recent months, the authors of this paper have seen an increase in the number of patients with a delayed or missed diagnosis of ruptured Achilles tendon presenting to their orthopaedic clinics. […] In a recent review of negligence claims in foot and ankle surgery, it was shown that delayed or missed diagnosis of ruptured Achilles tendon represented the third highest claim, with an average of 56 900 per case. […] Rupture of the Achilles tendon is a common injury, with approximately 4500 patients seeking medical help every year in the UK. […] A sudden pain in the back of the leg, with an audible snap, is the classic story in Achilles tendon rupture. […] Patients who think they sprained their ankle or calf may have ruptured their Achilles tendon. […] Patients with rupture of the Achilles tendon can still walk.

• #14 Achilles tendon rupture: how to avoid missing the diagnosis | British Journal of General Practice

  https://bjgp.org/content/65/641/668

  Patients with rupture of the Achilles tendon can still actively move the ankle up and down. […] Clinicians will never be falsely reassured by these history and examination findings if they remember to assess for Achilles tendon rupture specifically with the Simmonds calf squeeze test. […] The test is positive if, on the injured side, the foot does not move when the calf is squeezed. […] Imaging studies are not required to make the diagnosis in the acute situation, and frequently offer false reassurance. […] Although the debate regarding operative versus non-operative treatment is unresolved, the need for prompt recognition of this injury is paramount.

• #15 Achilles Tendon Injuries (Tear, Rupture) Causes, Symptoms, Treatments

  https://www.webmd.com/fitness-exercise/achilles-tendon-injury

  Doctors sometimes mistake an Achilles tendon injury for a sprained ankle. To make the right diagnosis, your doctor will start with a physical exam. They may want to see you walk or run so they can look for an issue that might have led to your injury. […] They also might do something called the calf squeeze test. You’ll kneel on a chair or bench or lie on your stomach on the exam table. Your doctor will gently squeeze the calf muscle on your healthy leg. This will pull on the tendon and make your foot move. Next, they’ll do the same thing on your other leg. If your Achilles tendon is torn, your foot won’t move because your calf muscle won’t be connected to your foot. […] Your doctor may test your range of motion to see if you can move your ankle the way you should. They may also do imaging tests, such as an X-ray or MRI. These tests can show what kind of tendon damage you have and help them decide on the best treatment for you.

• #16 Achilles tendon rupture – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/achilles-tendon-rupture/diagnosis-treatment/drc-20353239

  During the physical exam, your doctor will inspect your lower leg for tenderness and swelling. Your doctor might be able to feel a gap in your tendon if it has ruptured completely. […] The doctor might ask you to kneel on a chair or lie on your stomach with your feet hanging over the end of the exam table. He or she might then squeeze your calf muscle to see if your foot will automatically flex. If it doesn’t, you probably have ruptured your Achilles tendon. […] If there’s a question about the extent of your Achilles tendon injury whether it’s completely or only partially ruptured your doctor might order an ultrasound or MRI scan. These painless procedures create images of the tissues of your body.

• #17 Achilles Tendon Rupture: Symptoms, Treatment, Recovery | HSS

  https://www.hss.edu/conditions_achilles-tendon-rupture-injuries.asp

  How is an Achilles tendon rupture diagnosed? […] A doctor will ask the patient to describe their injury history and symptoms and will do a physical examination of the foot and ankle. Usually, a doctor can palpate the back of the ankle and feel a defect in the tendon, therefore identifying the location of the rupture. […] Doctors will also perform the Thompson Test by squeezing the calf muscle. If the foot does not move downward with this squeeze, this means the Achilles is not attached to the muscle and indicates a ruptured tendon. […] In some cases, X-rays, ultrasound and/or MRI imaging may be done to confirm the diagnosis or to rule out other injuries.

• #18 :: CIOS :: Clinics in Orthopedic Surgery

  https://ecios.org/DOIx.php?id=10.4055/cios.2020.12.1.1

  The diagnosis of acute Achilles tendon rupture is mostly based on a thorough history taking and physical examination. Typical patients are in their third or fourth decade of life and present with sudden inability to walk and acute pain during running or jumping. Patients with an acute rupture of the tendon often describe that they heard a popping sound in the back of the leg in dorsiflexion of the ankle or had the feeling of being kicked in the back of the ankle. Signs of a ruptured tendon include plantar flexion weakness, difficulty with weight-bearing ambulation, and limping. A false-negative Thompson test result can occur if plantar flexion is produced by intact extrinsic foot flexors; approximately 25% of acute ruptures are initially neglected for this reason. According to the American Academy of Orthopaedic Surgeons clinical practice guidelines, the diagnosis of an acute Achilles tendon rupture can be established by two or more of the following physical examination tests: (1) a positive Thompson test, (2) decreased plantar flexion strength, (3) presence of a palpable defect, and (4) increased passive ankle dorsiflexion with gentle manipulation. During diagnosis, it is important to differentiate traumatic sports injuries from low-energy injuries. The diagnosis of acute Achilles tendon rupture is primarily clinical, supported by imaging tests. Magnetic resonance imaging (MRI) or ultrasonography can be useful as a confirmatory test. Since MRI is not a dynamic imaging modality, it is not reliable in adequately determining partial or complete rupture. By contrast, ultrasonography is more effective in identifying the location of a tear, gap between the torn ends of the tendon, and partial/complete rupture. Plain radiography (lateral views of the ankle) is used in treatment planning. It also aids in identification of tendon swelling and increased soft tissue density in the Kager’s fat pad. Above all, it is superior to other imaging modalities in detecting presence of a calcific lesion, Haglund prominence, or calcaneus avulsion fracture, suggestive of preexisting degeneration or chronic tendinosis. In the case of a rupture in chronic Achilles tendinopathy, the risk of rerupture is high after either conservative treatment or direct repair. Direct healing of the pathologic tissue at the ruptured ends is oftentimes not feasible in this case. Then, the surgeon should consider other treatment options using healthy tissue, such as tendon reconstruction. Therefore, it is of utmost importance to confirm the presence or absence of pre-existing tendinopathy for differential diagnosis of acute Achilles tendon rupture. Plain radiography is a more appropriate than MRI or ultrasonography for this purpose.

• #19

  https://journals.lww.com/jaaos/fulltext/2010/08000/diagnosis_and_treatment_of_acute_achilles_tendon.7.aspx

  This clinical practice guideline is based on a series of systematic reviews of published studies in the available literature on the diagnosis and treatment of acute Achilles tendon rupture. […] The guideline provides practice recommendations and highlights gaps in the literature and areas that require future research. […] In the absence of reliable evidence, it is the opinion of this work group that a detailed history and physical examination be performed. The physical examination should include two or more of the following tests to establish the diagnosis of acute Achilles tendon rupture: Clinical Thompson test (ie, Simmonds squeeze test), Decreased ankle plantar flexion strength, Presence of a palpable gap (defect, loss of contour), Increased passive ankle dorsiflexion with gentle manipulation.

• #20

  https://journals.lww.com/jaaos/fulltext/2010/08000/diagnosis_and_treatment_of_acute_achilles_tendon.7.aspx

  This clinical practice guideline is based on a series of systematic reviews of published studies in the available literature on the diagnosis and treatment of acute Achilles tendon rupture. […] The guideline provides practice recommendations and highlights gaps in the literature and areas that require future research. […] In the absence of reliable evidence, it is the opinion of this work group that a detailed history and physical examination be performed. The physical examination should include two or more of the following tests to establish the diagnosis of acute Achilles tendon rupture: Clinical Thompson test (ie, Simmonds squeeze test), Decreased ankle plantar flexion strength, Presence of a palpable gap (defect, loss of contour), Increased passive ankle dorsiflexion with gentle manipulation.

• #21

  https://journals.lww.com/jaaos/fulltext/2010/08000/diagnosis_and_treatment_of_acute_achilles_tendon.7.aspx

  This clinical practice guideline is based on a series of systematic reviews of published studies in the available literature on the diagnosis and treatment of acute Achilles tendon rupture. […] The guideline provides practice recommendations and highlights gaps in the literature and areas that require future research. […] In the absence of reliable evidence, it is the opinion of this work group that a detailed history and physical examination be performed. The physical examination should include two or more of the following tests to establish the diagnosis of acute Achilles tendon rupture: Clinical Thompson test (ie, Simmonds squeeze test), Decreased ankle plantar flexion strength, Presence of a palpable gap (defect, loss of contour), Increased passive ankle dorsiflexion with gentle manipulation.

• #22

  https://journals.lww.com/jaaos/fulltext/2010/08000/diagnosis_and_treatment_of_acute_achilles_tendon.7.aspx

  This clinical practice guideline is based on a series of systematic reviews of published studies in the available literature on the diagnosis and treatment of acute Achilles tendon rupture. […] The guideline provides practice recommendations and highlights gaps in the literature and areas that require future research. […] In the absence of reliable evidence, it is the opinion of this work group that a detailed history and physical examination be performed. The physical examination should include two or more of the following tests to establish the diagnosis of acute Achilles tendon rupture: Clinical Thompson test (ie, Simmonds squeeze test), Decreased ankle plantar flexion strength, Presence of a palpable gap (defect, loss of contour), Increased passive ankle dorsiflexion with gentle manipulation.

• #23

  https://journals.lww.com/jaaos/fulltext/2010/08000/diagnosis_and_treatment_of_acute_achilles_tendon.7.aspx

  This clinical practice guideline is based on a series of systematic reviews of published studies in the available literature on the diagnosis and treatment of acute Achilles tendon rupture. […] The guideline provides practice recommendations and highlights gaps in the literature and areas that require future research. […] In the absence of reliable evidence, it is the opinion of this work group that a detailed history and physical examination be performed. The physical examination should include two or more of the following tests to establish the diagnosis of acute Achilles tendon rupture: Clinical Thompson test (ie, Simmonds squeeze test), Decreased ankle plantar flexion strength, Presence of a palpable gap (defect, loss of contour), Increased passive ankle dorsiflexion with gentle manipulation.

• #24 Achilles Tendon Rupture – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430844/

  Achilles tendon rupture is the most common tendon rupture in the lower extremity. Acute ruptures often present with sudden onset of pain associated with a „snapping” or audible „pop” heard at the injury site. Patients may describe a sensation similar to being kicked in the lower leg. […] The clinical diagnostic criteria for evaluating Achilles tendon ruptures are more sensitive than MRI studies. In addition, MRI studies can be expensive, time-consuming, and delay surgical treatment. For these reasons, MRI should only be obtained in ambiguous presentations and subacute or chronic injuries for preoperative planning. […] Following a thorough history and physical exam, the physician should determine whether the patient sustained an Achilles rupture, particularly when a positive Thompson test is 96% to 100% sensitive and 93% to 100% specific. […] Imaging tests, such as plain radiograph, MRI, or ultrasound, may be ordered to rule out other injuries and confirm the diagnosis of Achilles tendon rupture. […] Nevertheless, as previously mentioned, over 20% of Achilles tendon ruptures are misdiagnosed.

• #25 Achilles tendon tear | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/achilles-tendon-tear?lang=us

  Achilles tendon tears are the most common tendon ruptures. They are commonly seen secondary to sports-related injuries, especially squash and basketball. Acute Achilles tendon ruptures occur ~30 times (range 2.5-50) per 100,000 person-years. Patients are typically active middle-aged (~40 years) males with a sport-related rupture, although non-sporting ruptures occur in an older population (~55 years). Typically patients present with sudden onset of pain and swelling in the Achilles region, often accompanied by an audible snap during forceful dorsiflexion of the foot. Prior Achilles pain or injury has been reported in ~40% (range 33-46%) of patients with an acute Achilles tendon rupture. Clinical examination can be used in aiding diagnosis: calf-squeeze (Thompson) test examines the integrity of the Achilles tendon by squeezing the calf. Positive when foot does not move or minimally plantarflexes. Sensitivity 96%, specificity 93%, positive likelihood ratio 13.71, negative likelihood ratio 0.04 (based on one study). Ultrasound is considered the first-line imaging investigation as it is highly sensitive (97%) and specific (94%) for both partial thickness and full thickness tears.

• #26 Thompson Test for Achilles Tendon Rupture

  https://my.clevelandclinic.org/health/diagnostics/thompson-test-for-achilles-tendon-rupture

  The Thompson test is a quick, in-office physical test healthcare providers use to diagnose Achilles tendon ruptures (tears). […] A healthcare provider will perform a Thompson test if they think you might have a ruptured (torn) Achilles tendon. […] The Thompson test is an in-office physical exam, which means your provider can perform it without any special equipment or a separate appointment. […] If your provider thinks you might have a torn Achilles tendon, you’ll probably need at least one type of imaging test like an ultrasound or magnetic resonance imaging (MRI). […] The Thompson test doesn’t give the kind of results you might have gotten on other medical tests. Instead of giving an exact range or a specific number, it helps your provider understand whether or not your Achilles tendon is ruptured.

• #27 Diagnosing Achilles Injury | NYU Langone Health

  https://nyulangone.org/conditions/achilles-injury/diagnosis

  NYU Langone doctors use a physical exam and advanced imaging tests to diagnose injury to the Achilles tendon, including Achilles tendinitis and Achilles rupture. […] Our doctors conduct a physical exam and imaging tests to determine whether you have injured your Achilles. […] He or she may also assess your range of motion by asking you to walk or by using whats called a Thompson test. For this test, you lie face down on an exam table with your feet off the end. The doctor squeezes your calf muscle. If this action does not cause the toes to point downward, the Achilles tendon is likely ruptured. […] An MRI scan, which creates images of soft tissues in the body, including muscles and tendons, can help your doctor determine whether you have a partial or complete rupture and find its precise location along the tendon.

• #28 Achilles tendon rupture – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/achilles-tendon-rupture/diagnosis-treatment/drc-20353239

  During the physical exam, your doctor will inspect your lower leg for tenderness and swelling. Your doctor might be able to feel a gap in your tendon if it has ruptured completely. […] The doctor might ask you to kneel on a chair or lie on your stomach with your feet hanging over the end of the exam table. He or she might then squeeze your calf muscle to see if your foot will automatically flex. If it doesn’t, you probably have ruptured your Achilles tendon. […] If there’s a question about the extent of your Achilles tendon injury whether it’s completely or only partially ruptured your doctor might order an ultrasound or MRI scan. These painless procedures create images of the tissues of your body.

• #29 Achilles Tendon Rupture: Symptoms, Treatment, Recovery | HSS

  https://www.hss.edu/conditions_achilles-tendon-rupture-injuries.asp

  How is an Achilles tendon rupture diagnosed? […] A doctor will ask the patient to describe their injury history and symptoms and will do a physical examination of the foot and ankle. Usually, a doctor can palpate the back of the ankle and feel a defect in the tendon, therefore identifying the location of the rupture. […] Doctors will also perform the Thompson Test by squeezing the calf muscle. If the foot does not move downward with this squeeze, this means the Achilles is not attached to the muscle and indicates a ruptured tendon. […] In some cases, X-rays, ultrasound and/or MRI imaging may be done to confirm the diagnosis or to rule out other injuries.

• #30

  https://www.adelaideankle.com.au/achilles-tendon-rupture

  Achilles tendon rupture is when the Achilles tendon completely tears. […] The diagnosis of Achilles tendon rupture is usually straight-forward, and based on: symptoms, physical examination. […] A gap in the tendon, four to six centimetres above heel bone, is usually present. […] Gently squeezing the calf muscle helps determines if there is a connection between the calf and heel bone. […] If the Achilles tendon is intact, there will be flexion movement of the foot. […] If it is ruptured, no movement occurs. […] Unless the diagnosis is unclear or complicated by previous Achilles injury, no investigations are absolutely needed. […] Ultrasound shows the rupture and how much of a gap is present between the ends. […] MRI is usually only required in missed Achilles tendon rupture or if severe Achilles tendinopathy is suspected.

• #31 Achilles Tendon Rupture: Causes, Symptoms, Test, Treatment

  https://www.medicinenet.com/achilles_tendon_rupture/article.htm

  Patients with an Achilles tendon rupture will often complain of a sudden snap in the back of the leg. The pain is often intense and patients will describe it as if being shot. […] A healthcare professional makes a diagnosis of Achilles tendon rupture by taking a patient’s history and performing a physical exam as noted above. Imaging may be required to confirm the extent of tendon damage and to look for other associated injuries. […] The Thompson test helps confirm the diagnosis: The patient lies prone, face-down. The examiner squeezes the calf area. With an intact Achilles tendon, the foot will plantar flex and the toes point downward. With Achilles tendon rupture, the foot does not move. […] Plain X-rays of the foot may reveal swelling of the soft tissues around the ankle, other bone injury, or tendon calcification.

• #32 Thompson Test for Achilles Tendon Rupture

  https://my.clevelandclinic.org/health/diagnostics/thompson-test-for-achilles-tendon-rupture

  Your provider will classify your Thompson test as positive if they find anything that indicates that your Achilles tendon is ruptured. A negative result means your heel moved like it should or that your provider doesn’t think your Achilles is ruptured based on that one test. […] No matter which physical tests your provider uses, you’ll probably still need at least one type of imaging test to take pictures of your tendon and the area around it. […] Visit a healthcare provider right away if you think you have an Achilles tendon injury, even if you can walk or put some weight on it.

• #33 :: CIOS :: Clinics in Orthopedic Surgery

  https://ecios.org/DOIx.php?id=10.4055/cios.2020.12.1.1

  The diagnosis of acute Achilles tendon rupture is mostly based on a thorough history taking and physical examination. Typical patients are in their third or fourth decade of life and present with sudden inability to walk and acute pain during running or jumping. Patients with an acute rupture of the tendon often describe that they heard a popping sound in the back of the leg in dorsiflexion of the ankle or had the feeling of being kicked in the back of the ankle. Signs of a ruptured tendon include plantar flexion weakness, difficulty with weight-bearing ambulation, and limping. A false-negative Thompson test result can occur if plantar flexion is produced by intact extrinsic foot flexors; approximately 25% of acute ruptures are initially neglected for this reason. According to the American Academy of Orthopaedic Surgeons clinical practice guidelines, the diagnosis of an acute Achilles tendon rupture can be established by two or more of the following physical examination tests: (1) a positive Thompson test, (2) decreased plantar flexion strength, (3) presence of a palpable defect, and (4) increased passive ankle dorsiflexion with gentle manipulation. During diagnosis, it is important to differentiate traumatic sports injuries from low-energy injuries. The diagnosis of acute Achilles tendon rupture is primarily clinical, supported by imaging tests. Magnetic resonance imaging (MRI) or ultrasonography can be useful as a confirmatory test. Since MRI is not a dynamic imaging modality, it is not reliable in adequately determining partial or complete rupture. By contrast, ultrasonography is more effective in identifying the location of a tear, gap between the torn ends of the tendon, and partial/complete rupture. Plain radiography (lateral views of the ankle) is used in treatment planning. It also aids in identification of tendon swelling and increased soft tissue density in the Kager’s fat pad. Above all, it is superior to other imaging modalities in detecting presence of a calcific lesion, Haglund prominence, or calcaneus avulsion fracture, suggestive of preexisting degeneration or chronic tendinosis. In the case of a rupture in chronic Achilles tendinopathy, the risk of rerupture is high after either conservative treatment or direct repair. Direct healing of the pathologic tissue at the ruptured ends is oftentimes not feasible in this case. Then, the surgeon should consider other treatment options using healthy tissue, such as tendon reconstruction. Therefore, it is of utmost importance to confirm the presence or absence of pre-existing tendinopathy for differential diagnosis of acute Achilles tendon rupture. Plain radiography is a more appropriate than MRI or ultrasonography for this purpose.

• #34 Achilles tendon rupture – Wikipedia

  https://en.wikipedia.org/wiki/Achilles_tendon_rupture

  Diagnosis is primarily based on clinical symptoms and physical examination, with imaging such as ultrasound or MRI used for confirmation when needed. […] Diagnosis is based on symptoms and history of the event. People describe it like being kicked or shot behind the ankle. During physical examination, a gap may be felt above the heel unless swelling is present. A common physical exam test the doctor or provider may perform is the Simmonds’ test (aka Thompson test). […] Although a tear may be diagnosed by history and physical exam alone, an ultrasound scan is sometimes required to clarify or confirm the diagnosis. Once diagnosis is made, ultrasound imaging is an effective way to monitor the healing progress of the tendon over time. An ultrasound is recommended over MRI and MRI is generally not needed. […] Some conditions to consider when diagnosing an Achilles tendon tear are Achilles tendinitis, ankle sprain, and avulsion fracture of the calcaneus.

• #35 Thompson Test for Achilles Tendon Rupture

  https://my.clevelandclinic.org/health/diagnostics/thompson-test-for-achilles-tendon-rupture

  Your provider will classify your Thompson test as positive if they find anything that indicates that your Achilles tendon is ruptured. A negative result means your heel moved like it should or that your provider doesn’t think your Achilles is ruptured based on that one test. […] No matter which physical tests your provider uses, you’ll probably still need at least one type of imaging test to take pictures of your tendon and the area around it. […] Visit a healthcare provider right away if you think you have an Achilles tendon injury, even if you can walk or put some weight on it.

• #36 Achilles tendon rupture – Wikipedia

  https://en.wikipedia.org/wiki/Achilles_tendon_rupture

  Diagnosis is primarily based on clinical symptoms and physical examination, with imaging such as ultrasound or MRI used for confirmation when needed. […] Diagnosis is based on symptoms and history of the event. People describe it like being kicked or shot behind the ankle. During physical examination, a gap may be felt above the heel unless swelling is present. A common physical exam test the doctor or provider may perform is the Simmonds’ test (aka Thompson test). […] Although a tear may be diagnosed by history and physical exam alone, an ultrasound scan is sometimes required to clarify or confirm the diagnosis. Once diagnosis is made, ultrasound imaging is an effective way to monitor the healing progress of the tendon over time. An ultrasound is recommended over MRI and MRI is generally not needed. […] Some conditions to consider when diagnosing an Achilles tendon tear are Achilles tendinitis, ankle sprain, and avulsion fracture of the calcaneus.

• #37

  https://journals.lww.com/ijam/fulltext/2017/03001/diagnosis_of_achilles_tendon_rupture_with.38.aspx

  Achilles tendon rupture evaluated with lateral radiographs shows soft tissue swelling and an Achilles tendon tear is suggested when the Kager’s triangle is disrupted. […] While evaluating partial Achilles tendon ruptures, in 1990, Kalebo found that soft tissue radiography only showed localized swelling and that ultrasound was a better method for detection of ruptures. […] In the same study, Kalebo found that ultrasound was more accurate than computed tomography in identification of partial Achilles tendon ruptures. […] Advantages to ultrasound imaging include direct correlation of image findings with patient symptoms, dynamic imaging, wide availability of ultrasound equipment, lower cost than MRI, and speed of examination. […] For many patients with suspected tendon injury, ultrasound may be a fast and cost-effective method of evaluation. […] In summary, we provided a compelling argument for the utility of ultrasound in diagnosing Achilles’ tendon in the emergency setting.

• #38 Ultrasound imaging of value for diagnosis of Achilles tendon rupture in ED – Hospital Healthcare Europe

  https://hospitalhealthcare.com/clinical/radiology-and-imaging/ultrasound-imaging-of-great-valuable-for-minimising-diagnosis-of-achilles-tendon-rupture-in-ed/

  Ultrasound imaging has been found to be highly sensitive modality for the diagnosis of both partial and complete Achilles tendon rupture in ED […] The use of ultrasound imaging for the diagnosis of Achilles tendon rupture has been described in the literature although there have been no meta-analytic studies assessing the overall performance of this imaging modality as a diagnostic tool in emergency departments. […] The overall sensitivity of ultrasound for detecting a complete rupture was 94.8% (95% CI 91.3% 97.2%) and the specificity 98.7% (95% CI 97.03% 99.6%). […] The corresponding sensitivity was 93.7% (95% CI 95.3% 98.7%) and the specificity was 97.4% (95% CI 95.3% 98.7%). […] They concluded that ultrasound imaging is a useful and valuable modality to minimise the misdiagnosis of a partial or complete Achilles tendon rupture with an emergency department.

• #39

  https://journals.lww.com/ijam/fulltext/2017/03001/diagnosis_of_achilles_tendon_rupture_with.38.aspx

  Achilles tendon rupture evaluated with lateral radiographs shows soft tissue swelling and an Achilles tendon tear is suggested when the Kager’s triangle is disrupted. […] While evaluating partial Achilles tendon ruptures, in 1990, Kalebo found that soft tissue radiography only showed localized swelling and that ultrasound was a better method for detection of ruptures. […] In the same study, Kalebo found that ultrasound was more accurate than computed tomography in identification of partial Achilles tendon ruptures. […] Advantages to ultrasound imaging include direct correlation of image findings with patient symptoms, dynamic imaging, wide availability of ultrasound equipment, lower cost than MRI, and speed of examination. […] For many patients with suspected tendon injury, ultrasound may be a fast and cost-effective method of evaluation. […] In summary, we provided a compelling argument for the utility of ultrasound in diagnosing Achilles’ tendon in the emergency setting.

• #40

  https://journals.lww.com/ijam/fulltext/2017/03001/diagnosis_of_achilles_tendon_rupture_with.38.aspx

  Achilles tendon rupture evaluated with lateral radiographs shows soft tissue swelling and an Achilles tendon tear is suggested when the Kager’s triangle is disrupted. […] While evaluating partial Achilles tendon ruptures, in 1990, Kalebo found that soft tissue radiography only showed localized swelling and that ultrasound was a better method for detection of ruptures. […] In the same study, Kalebo found that ultrasound was more accurate than computed tomography in identification of partial Achilles tendon ruptures. […] Advantages to ultrasound imaging include direct correlation of image findings with patient symptoms, dynamic imaging, wide availability of ultrasound equipment, lower cost than MRI, and speed of examination. […] For many patients with suspected tendon injury, ultrasound may be a fast and cost-effective method of evaluation. […] In summary, we provided a compelling argument for the utility of ultrasound in diagnosing Achilles’ tendon in the emergency setting.

• #41

  https://journals.lww.com/ijam/fulltext/2017/03001/diagnosis_of_achilles_tendon_rupture_with.38.aspx

  Achilles tendon rupture evaluated with lateral radiographs shows soft tissue swelling and an Achilles tendon tear is suggested when the Kager’s triangle is disrupted. […] While evaluating partial Achilles tendon ruptures, in 1990, Kalebo found that soft tissue radiography only showed localized swelling and that ultrasound was a better method for detection of ruptures. […] In the same study, Kalebo found that ultrasound was more accurate than computed tomography in identification of partial Achilles tendon ruptures. […] Advantages to ultrasound imaging include direct correlation of image findings with patient symptoms, dynamic imaging, wide availability of ultrasound equipment, lower cost than MRI, and speed of examination. […] For many patients with suspected tendon injury, ultrasound may be a fast and cost-effective method of evaluation. […] In summary, we provided a compelling argument for the utility of ultrasound in diagnosing Achilles’ tendon in the emergency setting.

• #42

  https://journals.lww.com/ijam/fulltext/2017/03001/diagnosis_of_achilles_tendon_rupture_with.38.aspx

  Achilles tendon rupture evaluated with lateral radiographs shows soft tissue swelling and an Achilles tendon tear is suggested when the Kager’s triangle is disrupted. […] While evaluating partial Achilles tendon ruptures, in 1990, Kalebo found that soft tissue radiography only showed localized swelling and that ultrasound was a better method for detection of ruptures. […] In the same study, Kalebo found that ultrasound was more accurate than computed tomography in identification of partial Achilles tendon ruptures. […] Advantages to ultrasound imaging include direct correlation of image findings with patient symptoms, dynamic imaging, wide availability of ultrasound equipment, lower cost than MRI, and speed of examination. […] For many patients with suspected tendon injury, ultrasound may be a fast and cost-effective method of evaluation. […] In summary, we provided a compelling argument for the utility of ultrasound in diagnosing Achilles’ tendon in the emergency setting.

• #43

  https://journals.lww.com/ijam/fulltext/2017/03001/diagnosis_of_achilles_tendon_rupture_with.38.aspx

  Achilles tendon rupture evaluated with lateral radiographs shows soft tissue swelling and an Achilles tendon tear is suggested when the Kager’s triangle is disrupted. […] While evaluating partial Achilles tendon ruptures, in 1990, Kalebo found that soft tissue radiography only showed localized swelling and that ultrasound was a better method for detection of ruptures. […] In the same study, Kalebo found that ultrasound was more accurate than computed tomography in identification of partial Achilles tendon ruptures. […] Advantages to ultrasound imaging include direct correlation of image findings with patient symptoms, dynamic imaging, wide availability of ultrasound equipment, lower cost than MRI, and speed of examination. […] For many patients with suspected tendon injury, ultrasound may be a fast and cost-effective method of evaluation. […] In summary, we provided a compelling argument for the utility of ultrasound in diagnosing Achilles’ tendon in the emergency setting.

• #44

  https://journals.lww.com/ijam/fulltext/2017/03001/diagnosis_of_achilles_tendon_rupture_with.38.aspx

  Achilles tendon rupture evaluated with lateral radiographs shows soft tissue swelling and an Achilles tendon tear is suggested when the Kager’s triangle is disrupted. […] While evaluating partial Achilles tendon ruptures, in 1990, Kalebo found that soft tissue radiography only showed localized swelling and that ultrasound was a better method for detection of ruptures. […] In the same study, Kalebo found that ultrasound was more accurate than computed tomography in identification of partial Achilles tendon ruptures. […] Advantages to ultrasound imaging include direct correlation of image findings with patient symptoms, dynamic imaging, wide availability of ultrasound equipment, lower cost than MRI, and speed of examination. […] For many patients with suspected tendon injury, ultrasound may be a fast and cost-effective method of evaluation. […] In summary, we provided a compelling argument for the utility of ultrasound in diagnosing Achilles’ tendon in the emergency setting.

• #45 :: CIOS :: Clinics in Orthopedic Surgery

  https://ecios.org/DOIx.php?id=10.4055/cios.2020.12.1.1

  The diagnosis of acute Achilles tendon rupture is mostly based on a thorough history taking and physical examination. Typical patients are in their third or fourth decade of life and present with sudden inability to walk and acute pain during running or jumping. Patients with an acute rupture of the tendon often describe that they heard a popping sound in the back of the leg in dorsiflexion of the ankle or had the feeling of being kicked in the back of the ankle. Signs of a ruptured tendon include plantar flexion weakness, difficulty with weight-bearing ambulation, and limping. A false-negative Thompson test result can occur if plantar flexion is produced by intact extrinsic foot flexors; approximately 25% of acute ruptures are initially neglected for this reason. According to the American Academy of Orthopaedic Surgeons clinical practice guidelines, the diagnosis of an acute Achilles tendon rupture can be established by two or more of the following physical examination tests: (1) a positive Thompson test, (2) decreased plantar flexion strength, (3) presence of a palpable defect, and (4) increased passive ankle dorsiflexion with gentle manipulation. During diagnosis, it is important to differentiate traumatic sports injuries from low-energy injuries. The diagnosis of acute Achilles tendon rupture is primarily clinical, supported by imaging tests. Magnetic resonance imaging (MRI) or ultrasonography can be useful as a confirmatory test. Since MRI is not a dynamic imaging modality, it is not reliable in adequately determining partial or complete rupture. By contrast, ultrasonography is more effective in identifying the location of a tear, gap between the torn ends of the tendon, and partial/complete rupture. Plain radiography (lateral views of the ankle) is used in treatment planning. It also aids in identification of tendon swelling and increased soft tissue density in the Kager’s fat pad. Above all, it is superior to other imaging modalities in detecting presence of a calcific lesion, Haglund prominence, or calcaneus avulsion fracture, suggestive of preexisting degeneration or chronic tendinosis. In the case of a rupture in chronic Achilles tendinopathy, the risk of rerupture is high after either conservative treatment or direct repair. Direct healing of the pathologic tissue at the ruptured ends is oftentimes not feasible in this case. Then, the surgeon should consider other treatment options using healthy tissue, such as tendon reconstruction. Therefore, it is of utmost importance to confirm the presence or absence of pre-existing tendinopathy for differential diagnosis of acute Achilles tendon rupture. Plain radiography is a more appropriate than MRI or ultrasonography for this purpose.

• #46 Achilles Tendon Rupture – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430844/

  Achilles tendon rupture is the most common tendon rupture in the lower extremity. Acute ruptures often present with sudden onset of pain associated with a „snapping” or audible „pop” heard at the injury site. Patients may describe a sensation similar to being kicked in the lower leg. […] The clinical diagnostic criteria for evaluating Achilles tendon ruptures are more sensitive than MRI studies. In addition, MRI studies can be expensive, time-consuming, and delay surgical treatment. For these reasons, MRI should only be obtained in ambiguous presentations and subacute or chronic injuries for preoperative planning. […] Following a thorough history and physical exam, the physician should determine whether the patient sustained an Achilles rupture, particularly when a positive Thompson test is 96% to 100% sensitive and 93% to 100% specific. […] Imaging tests, such as plain radiograph, MRI, or ultrasound, may be ordered to rule out other injuries and confirm the diagnosis of Achilles tendon rupture. […] Nevertheless, as previously mentioned, over 20% of Achilles tendon ruptures are misdiagnosed.

• #47 MRI is Unnecessary for Diagnosing Acute Achilles Tendon Ruptures: Clinical Diagnostic Criteria

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3392388/

  The diagnosis of acute Achilles ruptures is based on clinical findings; imaging generally is not indicated except in cases of equivocal examination findings. […] Furthermore, the clinical diagnostic criteria used in our study were more sensitive than MRI studies. […] In the current study, physical examination findings, including an abnormal Thompson test, a palpable defect, and decreased resting tension, were more sensitive in diagnosing a complete Achilles rupture than MRI, leading to earlier diagnosis and treatment. MRI is time consuming, expensive, and can lead to a delay in treatment and misdiagnosis. Clinicians should rely primarily on the history and physical examination and have heightened awareness of a potential Achilles rupture based on the mechanism of injury for accurate diagnosis and management and reserve MRI for ambiguous presentations and subacute or chronic injuries for preoperative planning.

• #48 Achilles Tendon Rupture (Tear) – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/achilles-tendon-rupture-tear/

  While an X-ray gives doctors a clear view of bones, an MRI provides a better image of the soft tissues, such as tendons. […] The decision to perform surgery or not for an Achilles tendon tear is complex and personal. […] Surgical treatment of Achilles tendon tears is the topic of much ongoing research. […] Some studies have shown improved pushing off strength in patients who have surgical treatment for their Achilles tendon tear. […] The surgery may be performed with regional anesthetic, which numbs only your surgical leg, or general anesthetic, which puts you to sleep. […] Tendons can shorten and scar if too much time has passed since the injury. […] As with any surgery, infection, nerve injury, wound breakdown, complications from the anesthesia, and blood clots can occur. […] Most people can expect to return to their occupation (job) and activities of daily living after recovering from an Achilles tendon tear.

• #49 Achilles Tendon Injuries Workup: Approach Considerations, Imaging Studies

  https://emedicine.medscape.com/article/309393-workup

  Laboratory studies usually are not necessary in evaluating and diagnosing an Achilles tendon rupture or injury, although evaluation may help to rule out some of the other possibilities in the differential diagnosis. These laboratory tests, all of which are normal in Achilles tendinosis, include the following: […] Imaging studies can aid in the diagnosis and evaluation of Achilles tendon pathology, but typically they are not needed. Like laboratory studies, however, they can be helpful in evaluating possibilities in the differential diagnosis and should be ordered as clinically indicated. […] MRI can facilitate definitive diagnosis of a disrupted tendon. This is especially useful when considering the possibility of partial disruption of the Achilles tendon. Partial disruption often is undetectable clinically and may be misdiagnosed as simple Achilles tendinosis; however, partial Achilles disruption often responds to surgical intervention. […] MRI can also distinguish between paratenonitis, tendinosis, and bursitis. […] In tendinosis, increased MRI signal is evident in the tendon and degenerative changes, and partial tears may occasionally be seen. Keep in mind that these MRI findings may also be present in asymptomatic individuals.

• #50

  https://www.orthobullets.com/foot-and-ankle/7021/achilles-tendon-rupture

  Achilles Tendon Ruptures are common tendon injuries that occur due to sudden dorsiflexion of a plantarflexed foot, most commonly associated with sporting events. […] Diagnosis can be made clinically with weakness of plantarflexion with a positive Thompson’s test. MRI studies may be indicated for surgical management of chronic injuries. […] Imaging: Radiographs indications used to rule out other pathology. […] Ultrasound indications may be useful to determine complete vs. partial ruptures. […] MRI indications equivocal physical exam findings. […] MRI findings will show acute rupture with retracted tendon edges.

• #51 Achilles Tendon Injuries Workup: Approach Considerations, Imaging Studies

  https://emedicine.medscape.com/article/309393-workup

  Laboratory studies usually are not necessary in evaluating and diagnosing an Achilles tendon rupture or injury, although evaluation may help to rule out some of the other possibilities in the differential diagnosis. These laboratory tests, all of which are normal in Achilles tendinosis, include the following: […] Imaging studies can aid in the diagnosis and evaluation of Achilles tendon pathology, but typically they are not needed. Like laboratory studies, however, they can be helpful in evaluating possibilities in the differential diagnosis and should be ordered as clinically indicated. […] MRI can facilitate definitive diagnosis of a disrupted tendon. This is especially useful when considering the possibility of partial disruption of the Achilles tendon. Partial disruption often is undetectable clinically and may be misdiagnosed as simple Achilles tendinosis; however, partial Achilles disruption often responds to surgical intervention. […] MRI can also distinguish between paratenonitis, tendinosis, and bursitis. […] In tendinosis, increased MRI signal is evident in the tendon and degenerative changes, and partial tears may occasionally be seen. Keep in mind that these MRI findings may also be present in asymptomatic individuals.

• #52

  https://www.adelaideankle.com.au/achilles-tendon-rupture

  Achilles tendon rupture is when the Achilles tendon completely tears. […] The diagnosis of Achilles tendon rupture is usually straight-forward, and based on: symptoms, physical examination. […] A gap in the tendon, four to six centimetres above heel bone, is usually present. […] Gently squeezing the calf muscle helps determines if there is a connection between the calf and heel bone. […] If the Achilles tendon is intact, there will be flexion movement of the foot. […] If it is ruptured, no movement occurs. […] Unless the diagnosis is unclear or complicated by previous Achilles injury, no investigations are absolutely needed. […] Ultrasound shows the rupture and how much of a gap is present between the ends. […] MRI is usually only required in missed Achilles tendon rupture or if severe Achilles tendinopathy is suspected.

• #53 Achilles Tendon Rupture – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430844/

  Achilles tendon rupture is the most common tendon rupture in the lower extremity. Acute ruptures often present with sudden onset of pain associated with a „snapping” or audible „pop” heard at the injury site. Patients may describe a sensation similar to being kicked in the lower leg. […] The clinical diagnostic criteria for evaluating Achilles tendon ruptures are more sensitive than MRI studies. In addition, MRI studies can be expensive, time-consuming, and delay surgical treatment. For these reasons, MRI should only be obtained in ambiguous presentations and subacute or chronic injuries for preoperative planning. […] Following a thorough history and physical exam, the physician should determine whether the patient sustained an Achilles rupture, particularly when a positive Thompson test is 96% to 100% sensitive and 93% to 100% specific. […] Imaging tests, such as plain radiograph, MRI, or ultrasound, may be ordered to rule out other injuries and confirm the diagnosis of Achilles tendon rupture. […] Nevertheless, as previously mentioned, over 20% of Achilles tendon ruptures are misdiagnosed.

• #54 :: CIOS :: Clinics in Orthopedic Surgery

  https://ecios.org/DOIx.php?id=10.4055/cios.2020.12.1.1

  The diagnosis of acute Achilles tendon rupture is mostly based on a thorough history taking and physical examination. Typical patients are in their third or fourth decade of life and present with sudden inability to walk and acute pain during running or jumping. Patients with an acute rupture of the tendon often describe that they heard a popping sound in the back of the leg in dorsiflexion of the ankle or had the feeling of being kicked in the back of the ankle. Signs of a ruptured tendon include plantar flexion weakness, difficulty with weight-bearing ambulation, and limping. A false-negative Thompson test result can occur if plantar flexion is produced by intact extrinsic foot flexors; approximately 25% of acute ruptures are initially neglected for this reason. According to the American Academy of Orthopaedic Surgeons clinical practice guidelines, the diagnosis of an acute Achilles tendon rupture can be established by two or more of the following physical examination tests: (1) a positive Thompson test, (2) decreased plantar flexion strength, (3) presence of a palpable defect, and (4) increased passive ankle dorsiflexion with gentle manipulation. During diagnosis, it is important to differentiate traumatic sports injuries from low-energy injuries. The diagnosis of acute Achilles tendon rupture is primarily clinical, supported by imaging tests. Magnetic resonance imaging (MRI) or ultrasonography can be useful as a confirmatory test. Since MRI is not a dynamic imaging modality, it is not reliable in adequately determining partial or complete rupture. By contrast, ultrasonography is more effective in identifying the location of a tear, gap between the torn ends of the tendon, and partial/complete rupture. Plain radiography (lateral views of the ankle) is used in treatment planning. It also aids in identification of tendon swelling and increased soft tissue density in the Kager’s fat pad. Above all, it is superior to other imaging modalities in detecting presence of a calcific lesion, Haglund prominence, or calcaneus avulsion fracture, suggestive of preexisting degeneration or chronic tendinosis. In the case of a rupture in chronic Achilles tendinopathy, the risk of rerupture is high after either conservative treatment or direct repair. Direct healing of the pathologic tissue at the ruptured ends is oftentimes not feasible in this case. Then, the surgeon should consider other treatment options using healthy tissue, such as tendon reconstruction. Therefore, it is of utmost importance to confirm the presence or absence of pre-existing tendinopathy for differential diagnosis of acute Achilles tendon rupture. Plain radiography is a more appropriate than MRI or ultrasonography for this purpose.

• #55 Achilles Tendon Tears – Injuries; Poisoning – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/injuries-poisoning/sprains-and-other-soft-tissue-injuries/achilles-tendon-tears

  Achilles tendon tears (ruptures) most often result from ankle dorsiflexion, particularly when the tendon is taut. Diagnosis is by examination and sometimes MRI. […] Diagnosis of Achilles tendon tears is clinical. The patient’s ability to flex the ankle does not rule out a tear. […] If clinicians suspect an Achilles tendon tear, 3 main tests can be done to help confirm the diagnosis. […] Physical examination is more sensitive than MRI for detecting a Achilles tendon tear. A study of patients with an Achilles tendon tear (2012) found that if all 3 tests (Thompson, Matles, palpation of the gap) are positive, sensitivity for an Achilles tear is 100%. According to the American Academy of Orthopedic Surgeons guidelines (2009), diagnosis of a tear requires only one of the following: 2 of these 3 tests are positive or 1 of the tests is positive and ankle plantar flexion is weakened. […] Ultrasonography is being increasingly used to confirm tendon tears or to differentiate between partial and complete tears when imaging is required. Diagnostic accuracy appears to be good when done by experienced operators.

• #56 MRI is Unnecessary for Diagnosing Acute Achilles Tendon Ruptures: Clinical Diagnostic Criteria

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3392388/

  Achilles tendon ruptures are common in middle-aged athletes. Diagnosis is based on clinical examination or imaging. Although MRI is commonly used to document ruptures, there is no literature supporting its routine use and we wondered whether it was necessary. […] We (1) determined the sensitivity of physical examination in diagnosing acute Achilles ruptures, (2) compared the sensitivity of physical examination with that of MRI, and (3) assessed care delays and impact attributable to MRI. […] All patients had all three clinical findings preoperatively and complete ruptures intraoperatively (sensitivity of 100%). […] Physical examination findings were more sensitive than MRI. MRI is time consuming, expensive, and can lead to treatment delays. Clinicians should rely on the history and physical examination for accurate diagnosis and reserve MRI for ambiguous presentations and subacute or chronic injuries for preoperative planning.

• #57 Red flags and tests for Achilles tendon ruptures and tears

  https://www.treatmyachilles.com/post/red-flags-and-tests-for-achilles-tendon-ruptures-and-tears

  If you suspect that youve ruptured or torn your Achilles tendon, you must see a doctor as soon as possible. […] And then we discuss what scans are used to finally confirm the diagnosis of a ruptured or torn Achilles tendon. […] Its extremely important to have an Achilles tendon tear diagnosed and treated as soon as possible. […] If any of these red flags or tests makes you or your physio suspect that youve ruptured or partially torn your Achilles tendon, please see a doctor as soon as possible. […] The doctor will probably send you for a scan, because this is the only sure way to confirm the diagnosis of a ruptured or partially torn Achilles tendon and if so, what the extent of the damage is. […] This can be either an ultrasound scan or an MRI scan. […] The scan will show the extent of the tear whether its a rupture or a partial tear. If its a rupture, it will show how far the severed ends are apart which might influence your treatment options. If its a partial tear, it will show how much of the tendon has been torn. This will be the guide to what happens next. […] By the way, an X-ray is not useful for diagnosing Achilles ruptures and tears, because it only shows bones, not tendons.

• #58 Achilles tendon rupture – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/achilles-tendon-rupture/

  Diagnosis is clinical and may be confirmed on ultrasound or MRI. […] Clinical diagnosis of Achilles tendon rupture is based on 2 of the following examination findings: Abnormal Thompson test, Abnormal Matles test, Decreased plantar flexion strength, Palpable Achilles tendon gap. […] More than 20% of acute Achilles tendon ruptures are missed and subsequently become chronic ruptures. […] Consider imaging to confirm the diagnosis and/or exclude other suspected pathologies (e.g., fracture). […] Initial testing: x-ray, mainly used to exclude suspected fractures. […] Confirmatory studies: ultrasound and/or MRI can distinguish partial- and full-thickness tears.

• #59 :: CIOS :: Clinics in Orthopedic Surgery

  https://ecios.org/DOIx.php?id=10.4055/cios.2020.12.1.1

  The diagnosis of acute Achilles tendon rupture is mostly based on a thorough history taking and physical examination. Typical patients are in their third or fourth decade of life and present with sudden inability to walk and acute pain during running or jumping. Patients with an acute rupture of the tendon often describe that they heard a popping sound in the back of the leg in dorsiflexion of the ankle or had the feeling of being kicked in the back of the ankle. Signs of a ruptured tendon include plantar flexion weakness, difficulty with weight-bearing ambulation, and limping. A false-negative Thompson test result can occur if plantar flexion is produced by intact extrinsic foot flexors; approximately 25% of acute ruptures are initially neglected for this reason. According to the American Academy of Orthopaedic Surgeons clinical practice guidelines, the diagnosis of an acute Achilles tendon rupture can be established by two or more of the following physical examination tests: (1) a positive Thompson test, (2) decreased plantar flexion strength, (3) presence of a palpable defect, and (4) increased passive ankle dorsiflexion with gentle manipulation. During diagnosis, it is important to differentiate traumatic sports injuries from low-energy injuries. The diagnosis of acute Achilles tendon rupture is primarily clinical, supported by imaging tests. Magnetic resonance imaging (MRI) or ultrasonography can be useful as a confirmatory test. Since MRI is not a dynamic imaging modality, it is not reliable in adequately determining partial or complete rupture. By contrast, ultrasonography is more effective in identifying the location of a tear, gap between the torn ends of the tendon, and partial/complete rupture. Plain radiography (lateral views of the ankle) is used in treatment planning. It also aids in identification of tendon swelling and increased soft tissue density in the Kager’s fat pad. Above all, it is superior to other imaging modalities in detecting presence of a calcific lesion, Haglund prominence, or calcaneus avulsion fracture, suggestive of preexisting degeneration or chronic tendinosis. In the case of a rupture in chronic Achilles tendinopathy, the risk of rerupture is high after either conservative treatment or direct repair. Direct healing of the pathologic tissue at the ruptured ends is oftentimes not feasible in this case. Then, the surgeon should consider other treatment options using healthy tissue, such as tendon reconstruction. Therefore, it is of utmost importance to confirm the presence or absence of pre-existing tendinopathy for differential diagnosis of acute Achilles tendon rupture. Plain radiography is a more appropriate than MRI or ultrasonography for this purpose.

• #60 Achilles Tendon Rupture: Causes, Symptoms, Test, Treatment

  https://www.medicinenet.com/achilles_tendon_rupture/article.htm

  Patients with an Achilles tendon rupture will often complain of a sudden snap in the back of the leg. The pain is often intense and patients will describe it as if being shot. […] A healthcare professional makes a diagnosis of Achilles tendon rupture by taking a patient’s history and performing a physical exam as noted above. Imaging may be required to confirm the extent of tendon damage and to look for other associated injuries. […] The Thompson test helps confirm the diagnosis: The patient lies prone, face-down. The examiner squeezes the calf area. With an intact Achilles tendon, the foot will plantar flex and the toes point downward. With Achilles tendon rupture, the foot does not move. […] Plain X-rays of the foot may reveal swelling of the soft tissues around the ankle, other bone injury, or tendon calcification.

• #61 :: CIOS :: Clinics in Orthopedic Surgery

  https://ecios.org/DOIx.php?id=10.4055/cios.2020.12.1.1

  The diagnosis of acute Achilles tendon rupture is mostly based on a thorough history taking and physical examination. Typical patients are in their third or fourth decade of life and present with sudden inability to walk and acute pain during running or jumping. Patients with an acute rupture of the tendon often describe that they heard a popping sound in the back of the leg in dorsiflexion of the ankle or had the feeling of being kicked in the back of the ankle. Signs of a ruptured tendon include plantar flexion weakness, difficulty with weight-bearing ambulation, and limping. A false-negative Thompson test result can occur if plantar flexion is produced by intact extrinsic foot flexors; approximately 25% of acute ruptures are initially neglected for this reason. According to the American Academy of Orthopaedic Surgeons clinical practice guidelines, the diagnosis of an acute Achilles tendon rupture can be established by two or more of the following physical examination tests: (1) a positive Thompson test, (2) decreased plantar flexion strength, (3) presence of a palpable defect, and (4) increased passive ankle dorsiflexion with gentle manipulation. During diagnosis, it is important to differentiate traumatic sports injuries from low-energy injuries. The diagnosis of acute Achilles tendon rupture is primarily clinical, supported by imaging tests. Magnetic resonance imaging (MRI) or ultrasonography can be useful as a confirmatory test. Since MRI is not a dynamic imaging modality, it is not reliable in adequately determining partial or complete rupture. By contrast, ultrasonography is more effective in identifying the location of a tear, gap between the torn ends of the tendon, and partial/complete rupture. Plain radiography (lateral views of the ankle) is used in treatment planning. It also aids in identification of tendon swelling and increased soft tissue density in the Kager’s fat pad. Above all, it is superior to other imaging modalities in detecting presence of a calcific lesion, Haglund prominence, or calcaneus avulsion fracture, suggestive of preexisting degeneration or chronic tendinosis. In the case of a rupture in chronic Achilles tendinopathy, the risk of rerupture is high after either conservative treatment or direct repair. Direct healing of the pathologic tissue at the ruptured ends is oftentimes not feasible in this case. Then, the surgeon should consider other treatment options using healthy tissue, such as tendon reconstruction. Therefore, it is of utmost importance to confirm the presence or absence of pre-existing tendinopathy for differential diagnosis of acute Achilles tendon rupture. Plain radiography is a more appropriate than MRI or ultrasonography for this purpose.

• #62 Achilles Tendon Rupture (Tear) – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/achilles-tendon-rupture-tear/

  Achilles tendon tears can be either partial or complete. […] Your doctor will ask about the symptoms around your heel that you are experiencing. […] After discussing your symptoms and medical history, your doctor will conduct a thorough examination of your Achilles tendon. […] Doctors may use this Achilles tendon tear test to help diagnose an Achilles tendon tear. This test is called the Thompson test. […] Your doctor may order some imaging tests, such as an X-ray, ultrasound, or magnetic resonance imaging (MRI) scan. […] If the Achilles tendon tears from the insertion (attachment site) on the heel bone, the doctor may see a fleck of bone on the X-ray. This can be very helpful in making the diagnosis. […] An ultrasound can show the tendon in real time and will be able to determine both if there is a tear and, if so, how it responds when the ankle is moved.

• #63 Achilles Tendon Pain: Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/orthopedics/columbia-orthopedics/achilles-tendon-pain/treatment

  How is Achilles Tendon Pain Diagnosed? Diagnosis […] If you think you are experiencing Achilles tendon pain, you will probably want to visit a doctor. […] After discussing your symptoms, the doctor will perform a physical exam, including an assessment of your foot and ankle; they will inspect the area for: […] After a physical exam, the doctor will order imaging tests to determine if the condition is Achilles tendonitis or another problem. These tests might include the following: […] X-rays can provide clear images of bones; therefore, bone spurs on the back of the heel can be seen, suggesting insertional Achilles tendonitis. […] Ultrasound can help show the quality of the tendon through different ranges of motion and gives information on thickness, swelling, and tearing. […] MRI (Magnetic Resonance Imaging). This imaging test is typical if nonsurgical treatments have not proven effective. Depending on the severity of damage to the tendon, which can be visualized through an MRI, the doctor can plan which surgical procedure should be used.

• #64 :: CIOS :: Clinics in Orthopedic Surgery

  https://ecios.org/DOIx.php?id=10.4055/cios.2020.12.1.1

  The diagnosis of acute Achilles tendon rupture is mostly based on a thorough history taking and physical examination. Typical patients are in their third or fourth decade of life and present with sudden inability to walk and acute pain during running or jumping. Patients with an acute rupture of the tendon often describe that they heard a popping sound in the back of the leg in dorsiflexion of the ankle or had the feeling of being kicked in the back of the ankle. Signs of a ruptured tendon include plantar flexion weakness, difficulty with weight-bearing ambulation, and limping. A false-negative Thompson test result can occur if plantar flexion is produced by intact extrinsic foot flexors; approximately 25% of acute ruptures are initially neglected for this reason. According to the American Academy of Orthopaedic Surgeons clinical practice guidelines, the diagnosis of an acute Achilles tendon rupture can be established by two or more of the following physical examination tests: (1) a positive Thompson test, (2) decreased plantar flexion strength, (3) presence of a palpable defect, and (4) increased passive ankle dorsiflexion with gentle manipulation. During diagnosis, it is important to differentiate traumatic sports injuries from low-energy injuries. The diagnosis of acute Achilles tendon rupture is primarily clinical, supported by imaging tests. Magnetic resonance imaging (MRI) or ultrasonography can be useful as a confirmatory test. Since MRI is not a dynamic imaging modality, it is not reliable in adequately determining partial or complete rupture. By contrast, ultrasonography is more effective in identifying the location of a tear, gap between the torn ends of the tendon, and partial/complete rupture. Plain radiography (lateral views of the ankle) is used in treatment planning. It also aids in identification of tendon swelling and increased soft tissue density in the Kager’s fat pad. Above all, it is superior to other imaging modalities in detecting presence of a calcific lesion, Haglund prominence, or calcaneus avulsion fracture, suggestive of preexisting degeneration or chronic tendinosis. In the case of a rupture in chronic Achilles tendinopathy, the risk of rerupture is high after either conservative treatment or direct repair. Direct healing of the pathologic tissue at the ruptured ends is oftentimes not feasible in this case. Then, the surgeon should consider other treatment options using healthy tissue, such as tendon reconstruction. Therefore, it is of utmost importance to confirm the presence or absence of pre-existing tendinopathy for differential diagnosis of acute Achilles tendon rupture. Plain radiography is a more appropriate than MRI or ultrasonography for this purpose.

• #65 Achilles Tendon Rupture: Diagnosis & Treatment | Mass General Brigham

  https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/sports-medicine/conditions/foot-ankle/achilles-tendon-rupture/treatment

  Once your doctor has performed any necessary exams and imaging, they’ll assign your Achilles tendon rupture a grade from 1 to 3: Grade 1: A mild injury that brings minimal torn tendon fibers, known as a partially torn Achilles, Grade 2: A moderate injury with less than half the Achilles tendon fibers tearing, Grade 3: The most severe form of Achilles tendon injury, a rupture in which the majority or all the fibers tear. […] The red flags for Achilles tendon rupture are: A popping sound at the moment of injury, A feeling like you’ve been kicked in the calf, Swelling, bruising, and pain at the back of the ankle, especially during athletic activities like walking, running, and jumping, Swelling and thickening of the tendon, Instability and difficulty walking, especially on an incline or decline.

• #66 Achilles Tendon Rupture: Diagnosis & Treatment | Mass General Brigham

  https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/sports-medicine/conditions/foot-ankle/achilles-tendon-rupture/treatment

  Once your doctor has performed any necessary exams and imaging, they’ll assign your Achilles tendon rupture a grade from 1 to 3: Grade 1: A mild injury that brings minimal torn tendon fibers, known as a partially torn Achilles, Grade 2: A moderate injury with less than half the Achilles tendon fibers tearing, Grade 3: The most severe form of Achilles tendon injury, a rupture in which the majority or all the fibers tear. […] The red flags for Achilles tendon rupture are: A popping sound at the moment of injury, A feeling like you’ve been kicked in the calf, Swelling, bruising, and pain at the back of the ankle, especially during athletic activities like walking, running, and jumping, Swelling and thickening of the tendon, Instability and difficulty walking, especially on an incline or decline.

• #67 Achilles Tendon Rupture: Diagnosis & Treatment | Mass General Brigham

  https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/sports-medicine/conditions/foot-ankle/achilles-tendon-rupture/treatment

  Once your doctor has performed any necessary exams and imaging, they’ll assign your Achilles tendon rupture a grade from 1 to 3: Grade 1: A mild injury that brings minimal torn tendon fibers, known as a partially torn Achilles, Grade 2: A moderate injury with less than half the Achilles tendon fibers tearing, Grade 3: The most severe form of Achilles tendon injury, a rupture in which the majority or all the fibers tear. […] The red flags for Achilles tendon rupture are: A popping sound at the moment of injury, A feeling like you’ve been kicked in the calf, Swelling, bruising, and pain at the back of the ankle, especially during athletic activities like walking, running, and jumping, Swelling and thickening of the tendon, Instability and difficulty walking, especially on an incline or decline.

• #68 Achilles Tendon Rupture: Diagnosis & Treatment | Mass General Brigham

  https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/sports-medicine/conditions/foot-ankle/achilles-tendon-rupture/treatment

  Once your doctor has performed any necessary exams and imaging, they’ll assign your Achilles tendon rupture a grade from 1 to 3: Grade 1: A mild injury that brings minimal torn tendon fibers, known as a partially torn Achilles, Grade 2: A moderate injury with less than half the Achilles tendon fibers tearing, Grade 3: The most severe form of Achilles tendon injury, a rupture in which the majority or all the fibers tear. […] The red flags for Achilles tendon rupture are: A popping sound at the moment of injury, A feeling like you’ve been kicked in the calf, Swelling, bruising, and pain at the back of the ankle, especially during athletic activities like walking, running, and jumping, Swelling and thickening of the tendon, Instability and difficulty walking, especially on an incline or decline.

• #69 Achilles tendon rupture – Wikipedia

  https://en.wikipedia.org/wiki/Achilles_tendon_rupture

  Diagnosis is primarily based on clinical symptoms and physical examination, with imaging such as ultrasound or MRI used for confirmation when needed. […] Diagnosis is based on symptoms and history of the event. People describe it like being kicked or shot behind the ankle. During physical examination, a gap may be felt above the heel unless swelling is present. A common physical exam test the doctor or provider may perform is the Simmonds’ test (aka Thompson test). […] Although a tear may be diagnosed by history and physical exam alone, an ultrasound scan is sometimes required to clarify or confirm the diagnosis. Once diagnosis is made, ultrasound imaging is an effective way to monitor the healing progress of the tendon over time. An ultrasound is recommended over MRI and MRI is generally not needed. […] Some conditions to consider when diagnosing an Achilles tendon tear are Achilles tendinitis, ankle sprain, and avulsion fracture of the calcaneus.

• #70 Achilles tendon rupture – Wikipedia

  https://en.wikipedia.org/wiki/Achilles_tendon_rupture

  Diagnosis is primarily based on clinical symptoms and physical examination, with imaging such as ultrasound or MRI used for confirmation when needed. […] Diagnosis is based on symptoms and history of the event. People describe it like being kicked or shot behind the ankle. During physical examination, a gap may be felt above the heel unless swelling is present. A common physical exam test the doctor or provider may perform is the Simmonds’ test (aka Thompson test). […] Although a tear may be diagnosed by history and physical exam alone, an ultrasound scan is sometimes required to clarify or confirm the diagnosis. Once diagnosis is made, ultrasound imaging is an effective way to monitor the healing progress of the tendon over time. An ultrasound is recommended over MRI and MRI is generally not needed. […] Some conditions to consider when diagnosing an Achilles tendon tear are Achilles tendinitis, ankle sprain, and avulsion fracture of the calcaneus.

• #71 Achilles tendon rupture – Wikipedia

  https://en.wikipedia.org/wiki/Achilles_tendon_rupture

  Diagnosis is primarily based on clinical symptoms and physical examination, with imaging such as ultrasound or MRI used for confirmation when needed. […] Diagnosis is based on symptoms and history of the event. People describe it like being kicked or shot behind the ankle. During physical examination, a gap may be felt above the heel unless swelling is present. A common physical exam test the doctor or provider may perform is the Simmonds’ test (aka Thompson test). […] Although a tear may be diagnosed by history and physical exam alone, an ultrasound scan is sometimes required to clarify or confirm the diagnosis. Once diagnosis is made, ultrasound imaging is an effective way to monitor the healing progress of the tendon over time. An ultrasound is recommended over MRI and MRI is generally not needed. […] Some conditions to consider when diagnosing an Achilles tendon tear are Achilles tendinitis, ankle sprain, and avulsion fracture of the calcaneus.

• #72 Achilles tendon rupture – Wikipedia

  https://en.wikipedia.org/wiki/Achilles_tendon_rupture

  Diagnosis is primarily based on clinical symptoms and physical examination, with imaging such as ultrasound or MRI used for confirmation when needed. […] Diagnosis is based on symptoms and history of the event. People describe it like being kicked or shot behind the ankle. During physical examination, a gap may be felt above the heel unless swelling is present. A common physical exam test the doctor or provider may perform is the Simmonds’ test (aka Thompson test). […] Although a tear may be diagnosed by history and physical exam alone, an ultrasound scan is sometimes required to clarify or confirm the diagnosis. Once diagnosis is made, ultrasound imaging is an effective way to monitor the healing progress of the tendon over time. An ultrasound is recommended over MRI and MRI is generally not needed. […] Some conditions to consider when diagnosing an Achilles tendon tear are Achilles tendinitis, ankle sprain, and avulsion fracture of the calcaneus.

• #73 MRI is Unnecessary for Diagnosing Acute Achilles Tendon Ruptures: Clinical Diagnostic Criteria

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3392388/

  The diagnosis of acute Achilles ruptures is based on clinical findings; imaging generally is not indicated except in cases of equivocal examination findings. […] Furthermore, the clinical diagnostic criteria used in our study were more sensitive than MRI studies. […] In the current study, physical examination findings, including an abnormal Thompson test, a palpable defect, and decreased resting tension, were more sensitive in diagnosing a complete Achilles rupture than MRI, leading to earlier diagnosis and treatment. MRI is time consuming, expensive, and can lead to a delay in treatment and misdiagnosis. Clinicians should rely primarily on the history and physical examination and have heightened awareness of a potential Achilles rupture based on the mechanism of injury for accurate diagnosis and management and reserve MRI for ambiguous presentations and subacute or chronic injuries for preoperative planning.

• #74 Achilles Tendon Tears – Injuries; Poisoning – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/injuries-poisoning/sprains-and-other-soft-tissue-injuries/achilles-tendon-tears

  Achilles tendon tears (ruptures) most often result from ankle dorsiflexion, particularly when the tendon is taut. Diagnosis is by examination and sometimes MRI. […] Diagnosis of Achilles tendon tears is clinical. The patient’s ability to flex the ankle does not rule out a tear. […] If clinicians suspect an Achilles tendon tear, 3 main tests can be done to help confirm the diagnosis. […] Physical examination is more sensitive than MRI for detecting a Achilles tendon tear. A study of patients with an Achilles tendon tear (2012) found that if all 3 tests (Thompson, Matles, palpation of the gap) are positive, sensitivity for an Achilles tear is 100%. According to the American Academy of Orthopedic Surgeons guidelines (2009), diagnosis of a tear requires only one of the following: 2 of these 3 tests are positive or 1 of the tests is positive and ankle plantar flexion is weakened. […] Ultrasonography is being increasingly used to confirm tendon tears or to differentiate between partial and complete tears when imaging is required. Diagnostic accuracy appears to be good when done by experienced operators.

• #75 Achilles Tendon Rupture – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430844/

  Achilles tendon rupture is the most common tendon rupture in the lower extremity. Acute ruptures often present with sudden onset of pain associated with a „snapping” or audible „pop” heard at the injury site. Patients may describe a sensation similar to being kicked in the lower leg. […] The clinical diagnostic criteria for evaluating Achilles tendon ruptures are more sensitive than MRI studies. In addition, MRI studies can be expensive, time-consuming, and delay surgical treatment. For these reasons, MRI should only be obtained in ambiguous presentations and subacute or chronic injuries for preoperative planning. […] Following a thorough history and physical exam, the physician should determine whether the patient sustained an Achilles rupture, particularly when a positive Thompson test is 96% to 100% sensitive and 93% to 100% specific. […] Imaging tests, such as plain radiograph, MRI, or ultrasound, may be ordered to rule out other injuries and confirm the diagnosis of Achilles tendon rupture. […] Nevertheless, as previously mentioned, over 20% of Achilles tendon ruptures are misdiagnosed.

• #76 Achilles Tendon Rupture – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430844/

  Achilles tendon rupture is the most common tendon rupture in the lower extremity. Acute ruptures often present with sudden onset of pain associated with a „snapping” or audible „pop” heard at the injury site. Patients may describe a sensation similar to being kicked in the lower leg. […] The clinical diagnostic criteria for evaluating Achilles tendon ruptures are more sensitive than MRI studies. In addition, MRI studies can be expensive, time-consuming, and delay surgical treatment. For these reasons, MRI should only be obtained in ambiguous presentations and subacute or chronic injuries for preoperative planning. […] Following a thorough history and physical exam, the physician should determine whether the patient sustained an Achilles rupture, particularly when a positive Thompson test is 96% to 100% sensitive and 93% to 100% specific. […] Imaging tests, such as plain radiograph, MRI, or ultrasound, may be ordered to rule out other injuries and confirm the diagnosis of Achilles tendon rupture. […] Nevertheless, as previously mentioned, over 20% of Achilles tendon ruptures are misdiagnosed.

• #77 Achilles Tendon Tears – Injuries; Poisoning – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/injuries-poisoning/sprains-and-other-soft-tissue-injuries/achilles-tendon-tears

  Achilles tendon tears (ruptures) most often result from ankle dorsiflexion, particularly when the tendon is taut. Diagnosis is by examination and sometimes MRI. […] Diagnosis of Achilles tendon tears is clinical. The patient’s ability to flex the ankle does not rule out a tear. […] If clinicians suspect an Achilles tendon tear, 3 main tests can be done to help confirm the diagnosis. […] Physical examination is more sensitive than MRI for detecting a Achilles tendon tear. A study of patients with an Achilles tendon tear (2012) found that if all 3 tests (Thompson, Matles, palpation of the gap) are positive, sensitivity for an Achilles tear is 100%. According to the American Academy of Orthopedic Surgeons guidelines (2009), diagnosis of a tear requires only one of the following: 2 of these 3 tests are positive or 1 of the tests is positive and ankle plantar flexion is weakened. […] Ultrasonography is being increasingly used to confirm tendon tears or to differentiate between partial and complete tears when imaging is required. Diagnostic accuracy appears to be good when done by experienced operators.

• #78 Achilles Tendon Tears – Injuries; Poisoning – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/injuries-poisoning/sprains-and-other-soft-tissue-injuries/achilles-tendon-tears

  Achilles tendon tears (ruptures) most often result from ankle dorsiflexion, particularly when the tendon is taut. Diagnosis is by examination and sometimes MRI. […] Diagnosis of Achilles tendon tears is clinical. The patient’s ability to flex the ankle does not rule out a tear. […] If clinicians suspect an Achilles tendon tear, 3 main tests can be done to help confirm the diagnosis. […] Physical examination is more sensitive than MRI for detecting a Achilles tendon tear. A study of patients with an Achilles tendon tear (2012) found that if all 3 tests (Thompson, Matles, palpation of the gap) are positive, sensitivity for an Achilles tear is 100%. According to the American Academy of Orthopedic Surgeons guidelines (2009), diagnosis of a tear requires only one of the following: 2 of these 3 tests are positive or 1 of the tests is positive and ankle plantar flexion is weakened. […] Ultrasonography is being increasingly used to confirm tendon tears or to differentiate between partial and complete tears when imaging is required. Diagnostic accuracy appears to be good when done by experienced operators.

• #79 Achilles Tendon Rupture Test: How to, Diagnosis, Treatment

  https://www.healthline.com/health/achilles-tendon-rupture-test

  Healthcare professionals use the Achilles tendon rupture test to identify an Achilles tendon tear. The Achilles tendon rupture test is an effective diagnostic tool to identify a ruptured Achilles tendon. […] Prompt diagnosis is vital if you have an Achilles tendon rupture. […] While the tests are accurate, healthcare professionals cant rely on them as the sole diagnostic tool. They may need to perform imaging tests, such as an MRI or ultrasound, to confirm the diagnosis. […] The Achilles tendon rupture test is a quick assessment healthcare professionals use to identify a torn Achilles tendon. They may also use an MRI or ultrasound to confirm a diagnosis. […] If you think you have an Achilles tendon tear, getting medical attention from a healthcare professional is vital. They can provide a proper diagnosis and recommend appropriate treatment, which usually involves physical therapy and surgical and nonsurgical treatments.

• #80 Acute Rupture of Achilles Treatment | Henderson NV | Las Vegas NV

  https://feetmd.com/foot-ankle-conditions/achilles-tendon-problems/acute-rupture-of-achilles/

  It is important to realize that while Achilles tendon ruptures can be treated either non-operatively or operatively, they must be treated. […] A neglected Achilles tendon rupture (i.e. one where the tendon ends are not kept opposed) will lead to a marked dysfunction of the lower leg in gait, which will eventually lead to a whole host of other problems.

• #81 Achilles Tendon Rupture (Tear) – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/achilles-tendon-rupture-tear/

  While an X-ray gives doctors a clear view of bones, an MRI provides a better image of the soft tissues, such as tendons. […] The decision to perform surgery or not for an Achilles tendon tear is complex and personal. […] Surgical treatment of Achilles tendon tears is the topic of much ongoing research. […] Some studies have shown improved pushing off strength in patients who have surgical treatment for their Achilles tendon tear. […] The surgery may be performed with regional anesthetic, which numbs only your surgical leg, or general anesthetic, which puts you to sleep. […] Tendons can shorten and scar if too much time has passed since the injury. […] As with any surgery, infection, nerve injury, wound breakdown, complications from the anesthesia, and blood clots can occur. […] Most people can expect to return to their occupation (job) and activities of daily living after recovering from an Achilles tendon tear.

• #82 Acute Rupture of Achilles Treatment | Henderson NV | Las Vegas NV

  https://feetmd.com/foot-ankle-conditions/achilles-tendon-problems/acute-rupture-of-achilles/

  It is important to realize that while Achilles tendon ruptures can be treated either non-operatively or operatively, they must be treated. […] A neglected Achilles tendon rupture (i.e. one where the tendon ends are not kept opposed) will lead to a marked dysfunction of the lower leg in gait, which will eventually lead to a whole host of other problems.

• #83 Investigating the Validity of Soft Tissue Signs on Lateral Ankle X-Ray to Aid Diagnosis of Achilles Tendon Rupture in the Emergency Department

  https://clinmedjournals.org/articles/ijfa/international-journal-of-foot-and-ankle-ijfa-3-033.php

  To investigate the diagnostic validity of four radiological soft tissue signs Kager’s sign (K), disruption to the tendon (D), loss of parallelism (P) and fusiform swelling of the tendon (F) on a lateral ankle x-ray to aid Achilles tendon rupture diagnosis. […] Early diagnosis of Achilles tendon rupture is essential since delayed treatment may result in long term dysfunction including abnormal gait and chronic pain. […] Diagnosis is usually made clinically and relies on an array of subjective and objective tests. […] Despite Magnetic Resonance Imaging (MRI) being the gold standard for the diagnosis of Achilles tendon rupture, ultrasound is often used in the acute setting as it is cost effective, non-invasive and readily available. […] The aim of this study was to investigate the diagnostic validity (reliability and accuracy) of radiological soft tissue signs on a lateral ankle x-ray for an Achilles tendon rupture.

• #84 Achilles Tendon Rupture Test: How to, Diagnosis, Treatment

  https://www.healthline.com/health/achilles-tendon-rupture-test

  Healthcare professionals use the Achilles tendon rupture test to identify an Achilles tendon tear. The Achilles tendon rupture test is an effective diagnostic tool to identify a ruptured Achilles tendon. […] Prompt diagnosis is vital if you have an Achilles tendon rupture. […] While the tests are accurate, healthcare professionals cant rely on them as the sole diagnostic tool. They may need to perform imaging tests, such as an MRI or ultrasound, to confirm the diagnosis. […] The Achilles tendon rupture test is a quick assessment healthcare professionals use to identify a torn Achilles tendon. They may also use an MRI or ultrasound to confirm a diagnosis. […] If you think you have an Achilles tendon tear, getting medical attention from a healthcare professional is vital. They can provide a proper diagnosis and recommend appropriate treatment, which usually involves physical therapy and surgical and nonsurgical treatments.

• #85 Acute Achilles tendon rupture: diagnosis and management | Medicine Today

  https://medicinetoday.com.au/mt/2024/september/regular-series/acute-achilles-tendon-rupture-diagnosis-and-management

  The diagnosis of an acute ATR is primarily clinical, supported by imaging as required. […] The diagnosis of acute ATR on the basis of examination findings is discussed in the American Academy of Orthopedic Surgeons Clinical Practice Guideline on Treatment of Achilles Tendon Rupture. […] Imaging is not required for most patients who present with a suspected ATR but should be arranged if needed. […] The success of management, whether conservative or surgical, will be highly dependent on patient compliance with an agreed protocol, and all patients need to be made aware that poor outcomes can have significant implications and life-changing results. […] Referral to an orthopaedic surgeon should be arranged for patients who wish to be treated surgically and for those who are unsure about their management preferences.

• #86

  https://journals.lww.com/jaaos/fulltext/2010/08000/diagnosis_and_treatment_of_acute_achilles_tendon.7.aspx

  This clinical practice guideline is based on a series of systematic reviews of published studies in the available literature on the diagnosis and treatment of acute Achilles tendon rupture. […] The guideline provides practice recommendations and highlights gaps in the literature and areas that require future research. […] In the absence of reliable evidence, it is the opinion of this work group that a detailed history and physical examination be performed. The physical examination should include two or more of the following tests to establish the diagnosis of acute Achilles tendon rupture: Clinical Thompson test (ie, Simmonds squeeze test), Decreased ankle plantar flexion strength, Presence of a palpable gap (defect, loss of contour), Increased passive ankle dorsiflexion with gentle manipulation.

• #87 Acute Achilles tendon rupture: diagnosis and management | Medicine Today

  https://medicinetoday.com.au/mt/2024/september/regular-series/acute-achilles-tendon-rupture-diagnosis-and-management

  The diagnosis of an acute ATR is primarily clinical, supported by imaging as required. […] The diagnosis of acute ATR on the basis of examination findings is discussed in the American Academy of Orthopedic Surgeons Clinical Practice Guideline on Treatment of Achilles Tendon Rupture. […] Imaging is not required for most patients who present with a suspected ATR but should be arranged if needed. […] The success of management, whether conservative or surgical, will be highly dependent on patient compliance with an agreed protocol, and all patients need to be made aware that poor outcomes can have significant implications and life-changing results. […] Referral to an orthopaedic surgeon should be arranged for patients who wish to be treated surgically and for those who are unsure about their management preferences.

• #88 Achilles tendon rupture – Wikipedia

  https://en.wikipedia.org/wiki/Achilles_tendon_rupture

  Diagnosis is primarily based on clinical symptoms and physical examination, with imaging such as ultrasound or MRI used for confirmation when needed. […] Diagnosis is based on symptoms and history of the event. People describe it like being kicked or shot behind the ankle. During physical examination, a gap may be felt above the heel unless swelling is present. A common physical exam test the doctor or provider may perform is the Simmonds’ test (aka Thompson test). […] Although a tear may be diagnosed by history and physical exam alone, an ultrasound scan is sometimes required to clarify or confirm the diagnosis. Once diagnosis is made, ultrasound imaging is an effective way to monitor the healing progress of the tendon over time. An ultrasound is recommended over MRI and MRI is generally not needed. […] Some conditions to consider when diagnosing an Achilles tendon tear are Achilles tendinitis, ankle sprain, and avulsion fracture of the calcaneus.

• #89 Thompson Test for Achilles Tendon Rupture

  https://my.clevelandclinic.org/health/diagnostics/thompson-test-for-achilles-tendon-rupture

  Your provider will classify your Thompson test as positive if they find anything that indicates that your Achilles tendon is ruptured. A negative result means your heel moved like it should or that your provider doesn’t think your Achilles is ruptured based on that one test. […] No matter which physical tests your provider uses, you’ll probably still need at least one type of imaging test to take pictures of your tendon and the area around it. […] Visit a healthcare provider right away if you think you have an Achilles tendon injury, even if you can walk or put some weight on it.

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