1. TENDO-
ACHILLES
INJURY

2. ANATOMY

3. ANATOMY

4. ANATOMY

5. MECHANISM
• DIRECT BLOW
• SUDDEN DORSIFLEXION OF
ANKLE
• ACCIDENTAL SLIPPAGE INTO
WATER CLOSET
HIGHLEVEL LOWLEVEL

6. • HIGH LEVEL INJURY
FOOT DORSIFLEXED AT
TIME OF SLIPPAGE
INJURY 3-4cm ABOVE
INSERTION
HEAL WELL AFTER REPAIR

7. LOW LEVEL INJURY
•TRIES TO TAKE OUT FOOT IN
PLANTAR FLEXED POSITION
• SLICING OF TENDON AT A
LOWER LEVEL
• POOR HEALING

8. CHRONIC
• DUE TO GRADUAL WEAKENING OF
TENDON
• AGE>40
• INVOLVT IN ACTIVE ATHLETICS
• H/O TENDINITIS
• LOSS OF FLEXIBILITY OF TENDO
ACHILLES

9. SYMPTOMS
• SUDDEN PAIN
• AUDIBLE SNAP
• WEAK PLANTAR FLEXION
• PROMINENCE OF ACHILLES
TENDON LOST

10. SIGNS
• TIPTOE STANDING-LAG
• PALPABLE DEFECT
• THOMPSON’S TEST
• O BRIEN’S NEEDLE TEST

12. THOMPSON’S TEST

13. INVESTIGATIONS
• PLAIN X-RAY-NO BONY INJURY
• MRI
• PHYSICAL EXAMN DIAGNOSTIC

15. TREATMENT
SURGICAL
ACTIVE INDIVIDUALS
RERUPTURE
INJURY>2 WEEKS
RISK OF WOUND HEALING
PROBLEMS

16. NONSURGICAL
• SEDENTARY INDIVIDUALS
• HIGH RISK SURGICAL PTS
• INC RISK OF WOUND PROBLEMS
• CHANCE OF RERUPTURE +

17. NONSURGICAL
• GRAVITY EQUINUS CAST
• BELOW KNEE CAST
• APPLIED FOR 3 MONTHS
• FOLLOWED BY SUPERVISED
STRENGTHENING ACTIVITIES

18. SURGICAL
APPROACH THROUGH MEDIAL
SIDE OF TENDON SHEATH
FOOT IN EQUINUS=RESTING
EQUINUS OF OPP ANKLE
EDGES APPROXIMATED-bunnel or
kessler stitch
PLANTARIS REINFORCE REPAIR

19. CHRONIC RUPTURE
• GASTRONEMIUS FASCIA
SUTURED TO DISTAL STUMP
• V-Y LENGTHENING OF
GASTRONEMIUS APONEUROSIS
• TRANSFER OF FHL TENDON
• REPAIR USING PERONEUS BREVIS

20. COMPLICATIONS
• RERUPTURE
• PARTIAL RUPTURE
• NECROSIS
• SLOUGHING
• INFECTION