| |
Ryan Fitzgerald, DPM
PRESENT RI Associate Editor
Hess Orthopedics &
Sports Medicine
Harrisonburg, Virginia
|
Case Presentation:
A 44-y/o Male with a Neglected
Achilles
Tendon Rupture
HPI: The patient is a pleasant 44-year-old male who presents to the office with persistent pain and weakness about the left ankle. He relates that approximately two months previous to his presentation, he was playing basketball and felt a “pop” in the back of his ankle, but that because he did not have health insurance at the time of the injury, he did not seek treatment. He has now started a new job and therefore presents today for evaluation. He does relate to pain with motion and difficulty with walking, particularly up and down stairs. He grades his pain, when it is at its worse, as 8/10.
|
|
|
| Figure 1: Complete disruption with retraction of the tendon was noted on MRI. |
|
|
| |
|
PMH: Asthma
PSH: Tonsillectomy as a child
Medications: Albuterol inhaler, daily multivitamin
Physical Exam: The patient exhibits a normal body habitus, weighs approximately 210 lbs, and stands 5� 9�� tall. He demonstrates palpable pedal pulses that are graded as +2/4 at the dorsalis pedis and posterior tibial arteries. CFT is less than 3 seconds in the digits. There are no varicosities or telangectasias noted. He does demonstrate some mild swelling about the left ankle. However, there is no ecchymosis or other skin lesions noted. Evaluation of muscle strength on the right demonstrates +5/5 in dorsiflexion, plantarflexion, inversion and eversion, with no pain or crepitation noted. Evaluation of the left foot demonstrates significant weakness in resisted plantarflexion, although the patient does demonstrate the ability to passively plantarflex his foot at the ankle. Ankle ROM does elicit pain. There is pain with palpation along the course of the Achilles tendon distally about the left ankle, and there is a palpable dell noted in the area of the watershed region of the Achilles tendon.
Imaging Studies: plain film radiographs were negative. MRI images demonstrate a complete disruption of the Achilles tendon approximately 6 cm proximal to the insertion with a 3.7cm gap within the tendon (fig. 1).
Considering the clinical exam presented, and the physical and imaging findings, how would you proceed in the management of this patient? Follow this link, or click on the image below, to participate in the on going eTalk thread on this topic. The Conclusion of this case will be posted in an upcoming Residency Insight.
We love hearing from you. I encourage all of our readers to participate in the online forum in the E-talk thread on this topic, and post your thoughts, pearls, and perspectives regarding this (or any other) interesting case.
Get a steady stream of all the NEW PRESENT Podiatry
eLearning by becoming our Facebook Fan.
Effective eLearning and a Colleague Network await you. |
 |
.jpg)
