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Hi Stephen, this was a 21 yr woman who caught her Achilles and cut it requiring stitches at A+E one month ago. It’s not improved over this time and she is limping heavily because she has some reduction in her plantar strength. Thomson calf squeeze was normal. I’ve called it a full thickness, partial width tear. The cut threw me a little as I was wondering whether it was deeper than the medics suspected but the tear is about an inch above the cut scar so I guess the jarring of the ankle caused the Achilles disruption. My question is does it look like I’ve categorised it correctly to you and what do you make of the disruption inferior to the tendon (sorry didn’t record the best picture of this) is there some disruption of soleus as well do you think? I’ve referred her for orthopaedic opinion for treatment. Thank you, Mike
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It is certainly a major injury,
It looks like the majority of the tendon has been severed and only a minor portion is uninvolved.
I am not surprised the Thompson test is normal as it is not a complete rupture.
I think your description of full thickness / partial width is a fair way to describe it.
I think the soles muscle is probably OK,
The peritenon is also very thick as this would have been cut and now I suspect there is a lot of fibrosis of the peritenon which would restrict free movement of the tendon.
I agree an orthopaedic opinion is essential.
I would also recommend an MRI as this may add to the management planning.
Let us know if you get an MRI report.
Nice case Michael,
Keep us informed.
Steve
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