Lauren Warshaw, MS4

The Article: Odom, M., Haas, N., Phillips, K. “BEDSIDE ULTRASOUND DIAGNOSIS

OF COMPLETE ACHILLES TENDON TEAR IN A 25-YEAR-OLD MAN WITH CALF

INJURY”. The Journal of Emergency Medicine 2018; 524: 694-696.

The Idea: A 25 year-old man presented to the Emergency Department after his right

heel was stepped on from behind while his foot was planted the day prior. He was still

able to bear weight on his right foot. In the ED, there was swelling and ecchymosis of

the right posterior lower leg and a palpable tissue defect proximal to the calcaneus.

Physical exam was consistent with an Achilles tendon rupture. An ultrasound was

performed with a linear probe in the longitudinal plane, revealing an anechoic defect in

the distal Achilles tendon fibers.

The Takeaway: Despite the strength and size of the AT, it is one of the most commonly

injured tendons and the rate of rupture is increasing likely secondary to increased

participation in sports across a wider range of age groups. AT rupture occurs most often

with forceful plantar flexion or sudden dorsiflexion. Risk factors include systemic steroid

use, quinolone and auto immune or inflammatory disorders. Presentation includes

posterior leg pain often with a loud popping noise. Patients often cannot plantar flex or

toe walk. Ultrasound has been shown to be a viable imaging modality with a sensitivity

and specificity of 100% and 83% respectively. An anechoic defect that transects the

tendon is consistent with a full thickness tear. Other features include tendon retraction

and posterior acoustic shadowing. For treatment, surgical management is mainly used

for young patients or athletes. Given its availability, low cost, and lack of ionizing

radiation, point of care ultrasound should be utilized for Achilles rupture diagnosis.