A Segmental Rupture of Achilles Tendon, its Management, and Outcome - A Rare Case Report

Achilles tendon is the thickest and strongest tendon of the body, spanning from the middle of the calf up to its insertion into the calcaneal tuberosity, and it is estimated to be the third most frequent tendon to rupture. Segmental Achilles tendon rupture, however, is a very rare occurrence and it comes with challenges of salvaging the tendon segment, preventing necrosis of the overlying skin, preventing infection, and preserving the repaired construct to regain good functional outcome. We present a rare case of an acute traumatic segmental rupture of Achilles tendon in a young male, its management and outcome.

A 25-year-old male suffered a direct blow to the posterior aspect of his left ankle above the heel and presented to us on the same day. On examination, a lacerated wound with visible ruptured ends of the tendon was found. A palpable gap was also felt over a proximal sutured wound and a real-time ultrasonography revealed a complete tear of Achilles tendon in the proximal site as well. Both the wounds were explored and a segmental Achilles tendon rupture was found. A dual level Krackow's suturing was done with augmentation of the distal repair with anchorage in the calcaneus. Following a stringent post-operative rehabilitation, the patient was allowed weight-bearing from 12 weeks onward. At 6-month follow-up, the tendon continuity was intact both clinically and radiologically, and the patient was able to ambulate bearing full weight having bilaterally comparable ankle range of motion.

Rupture of Achilles tendon is relatively common; however, a segmental rupture of the tendon is very rare and poses a challenge for optimum management. Awareness about the possible complications and addressing them with a timely intervention followed by a well-balanced rehabilitation can salvage the tendon and yield good results.