How to heal the heel
Author: Juan Pablo Nieto, MD
Peer-reviewer: Brandon Godfrey, MD
Final editor: Alex Tomesch, MD
A 45 year-old male and "weekend warrior" presents with sudden onset of posterior heel pain while playing basketball and also states he felt a 'pop'. He is tender at the distal posterior ankle and unable to fully plantarflex the foot. He has the following ultrasound findings.
Image 1. Case courtesy of Dr Bruno Di Muzio, From the case rID: 11022
What is your diagnosis?
This patient is diagnosed with an Achilles tendon rupture. This injury is typically caused by pushing off suddenly with the forefoot while extending the knee. The tendon usually tears 2-6 cm proximal to its distal insertion where there is poor blood supply. [2]
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Pearl: Positive Thompson sign is diagnostic. Squeeze calf muscle and watch for plantarflexion, if absent, it is consistent with Achilles tendon rupture.
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Pearl: To avoid missing a calcaneal avulsion fracture which requires surgical treatment, obtain ankle radiographs and look for this fracture on the lateral view
Image 2. Case courtesy of Assoc Prof Frank Gaillard, from the case rID: 35974 [4]
References
[1] Case courtesy of Dr Bruno Di Muzio, <a href="/https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="/https://radiopaedia.org/cases/11022">rID: 11022</a>
[2] Achar, S. A., & Taylor, K. S. (2020). The 5-minute sports Medicine Consult (3rd ed.). Wolters Kluwer.
[3] Achar, S. A., & Taylor, K. S. (2020). The 5-minute sports Medicine Consult (3rd ed.). Wolters Kluwer.
[4] Case courtesy of Assoc Prof Frank Gaillard, <a href="/https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="/https://radiopaedia.org/cases/35974">rID: 35974</a>
[5] Cetti R, Christensen SE, Ejsted R, et al. Operative versus nonoperative treatment of Achilles tendon rupture. A prospective randomized study and review of the literature. Am J Sports Med. 1993;21:791-799 [PMID:8291628]