The patient describes a sudden onset of acute
pain in the Achilles region immediately followed by grossly diminished
Rupture of Achilles tendon is an uncommon complication of treatment
with fluoroquinolones and Corticosteroids.
The patient will often describe a feeling 'as if I was hit or
kicked in the back of the leg'. A snap or tear may be audible.
Ultrasonography of the Achilles tendon with linear probes produces
a dynamic and panoramic image of the tendon The Achilles tendon
is composed of longitudinally arranged collagen bundles, which
reflect the ultrasound beam.
A normal Achilles tendon (scan 1 > right) appears as a hypoechogenic,
ribbon-like image that is contained within two hyperechogenic
bands. Tendon fascicles appear as alternate hypoechogenic and
hyperechogenic bands that are separated when the tendon is relaxed
and are more compact when the tendon is strained.
If there is a rupture of the achilles tendon, an increase in the
volume and thickness of the tendon and its heterogeneous appearance
was the most frequently observed feature. The most characteristic
sign of ruptured AT is a break in continuity.
Rupture of the Achilles tendon is seen on ultrasonography scans
as an acoustic vacuum with thick, irregular edges.
Ultrasonography also can be used to study the elastic properties
of the tendon; this is done by measuring the distance between
an intratendinous hypoechogenic or hyperechogenic point and the
calcaneus and by assessing how this distance changes with different
forces exerted by the gastrocnemius-soleus complex.
Also, Sonography can be used to differentiate full- from partial-thickness
tears or tendinosis of the Achilles tendon.
If there is a complete rupture of the achilles tendon then surgery
will be often necessary.