Tendon rupture may follow a single high energy event, but is often the culmination of recurrent minor tears or following recent tendonitis
Risk factors
Diabetes
RA
Steroid use
Clinical presentation
Symptoms
Sudden deceleration with resisted calf muscle contraction (eg lunging at squash) leads to sudden pain (like being kicked in the back of the leg) and difficulty weight bearing
Signs
Weakness of plantar flexion and a palpable gap in the tendon are usually apparent
Unable to tiptoe stand
Positive calf squeeze (Simmonds) test
Investigations
US or MRI can be used to distinguish between complete and partial tears
US is often easier for patients and allows dynamic assessment
Management
Surgical management
Suture repair of tendon
Wound problems can occur with surgery and can be very problematic if healing does not occur
Conservative management
Series of casts in the equinous position
The ankle is platarflexed with the toes pointing down, which closes the gap in the torn tendon over 8 weeks or so
This avoids the potential for wound problems and good functional outcome can usually be expected
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