What iIs Your Diagnosis? ANSWER: ACHILLES TENDON RUPTURE

摘要

This patient has an Achilles tendon rupture. Tears usually occur in an avascular area 2 to 6 cm proximal to the calcaneal insertion. Causes of rupture include high-energy disruption, degenerative changes, and mechanical imbalance. Risk factors for rupture include corticosteroid or quinolone use, chronic disease (eg, rheumatoid arthritis, systemic lupus erythematosus, and diabetes mellitus), and poor footwear. DIAGNOSIS The diagnosis is typically clinical. The most used adjunct to clinical examination is the Thompson test. Also known as the Simmonds test or calf squeeze, this test was first described in 1957.2 The patient is placed either prone with feet hanging off the examination table or with knees flexed and legs hanging off the table. The examiner squeezes both calves. If the tendon is intact, squeezing produces plantar flexion. The test is considered positive if the affected foot remains neutral or has minimal plantar flexion compared with the unaffected foot.