Journal of Orthopaedic & Sports Physical Therapy

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musculoskeletal imaging

FIGURE 1. The Matles test, which assesses resting tension in the Achilles tendon,1 is performed
by assessing the position of the ankles with the knees flexed to 90.2 With an intact Achilles
tendon, the resting position of the patients ankle should be in approximately 20 to 30 of
plantar flexion (left). With a ruptured Achilles tendon, the resting position of the patients ankle
is in a neutral or dorsiflexed position (right).

FIGURE 2. Fat-saturated, T2-weighted magnetic resonance image (sagittal view) demonstrating a complete rupture of the Achilles tendon, as identified by a 3-mm fluid-filled tendon gap
(arrow). The Achilles tendon is also thickened with extensive high-signal edema in the tendon
and surrounding connective tissue, indicating reaction to injury.

Achilles Tendon Rupture

MARIO F. CRUZ, PT, DPT, ATC, Physical Therapist, OrthoAtlanta, Orthopaedic and Sports Medicine Specialists, Newnan, GA.
SUSAN S. JORDAN, MD, Orthopaedic Surgeon, OrthoAtlanta, Orthopaedic and Sports Medicine Specialists, Newnan, GA.
LORI A. BOLGLA, PT, PhD, ATC, Associate Professor, Department of Physical Therapy, College of Allied Health Sciences,
College of Graduate Studies, Georgia Health Sciences University, Augusta, GA.

he patient was a 30-year-old

man who was referred to a physical
therapist for a chief complaint of a
painful, swollen left lower leg that had
caused difficulty with walking in the previous 3 weeks. Symptom onset occurred
suddenly while playing basketball, when
the patient had his left heel stepped on
by another player, which caused a popping sensation and immediate pain in the
left heel region. Prior to physical therapist referral, the patients primary care
provider ordered radiographs of the left
ankle, which were interpreted as normal.
Visual observation revealed an antal-

gic gait with decreased stance phase for

the left lower extremity and moderate
edema of the left ankle. Palpation of the
Achilles tendon elicited exquisite pain,
and a palpable defect in the tendon was
noted approximately 4 cm proximal to
its calcaneal insertion. With the patient
lying prone with his knee flexed to 90,
his left ankle fell into a dorsiflexed position, while the right ankle remained in
a slightly plantar flexed position (FIGURE
1).1 There was an absence of ankle plantar
flexion when the physical therapist manually squeezed the left calf muscle,1,2 and
the patient was also unable to perform a

unilateral left heel raise.

Due to history and physical examination findings that were concerning for
an Achilles tendon rupture,1 the physical
therapist immediately referred the patient to an orthopaedic surgeon. Magnetic
resonance imaging, which was primarily
ordered to assess the degree of tendon
retraction and tissue quality, confirmed
the presence of a complete rupture of the
Achilles tendon (FIGURE 2).1 The patient
subsequently underwent Achilles tendon repair 6 weeks after his injury. t J
Orthop Sports Phys Ther 2013;43(2):105.
doi:10.2519/jospt.2013.0403

References
1. Garras DN, Raikin SM, Bhat SB, Taweel N, Karanjia H. MRI is unnecessary for diagnosing acute Achilles tendon ruptures: clinical diagnostic criteria. Clin Orthop Relat Res.
2012;470:2268-2273. http://dx.doi.org/10.1007/s11999-012-2355-y
2. Maffulli N. The clinical diagnosis of subcutaneous tear of the Achilles tendon: a prospective study in 174 patients. Am J Sports Med. 1998;26:188-193.

journal of orthopaedic & sports physical therapy | volume 43 | number 2 | february 2013 |

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