AMC Clinical exam-recalls

A 45 year old waiter, John, comes to you because he has increasing difficulties with his job. About 3 days ago he recently experienced a strange incident when he was carrying a heavy trays, he felt a sudden pain in the back of his right foot, just above the ankle. He was sure that one of the customers had kicked him but they all denied it.
Since then he has had trouble walking with weakness when he tries to push himself off the ground with his right foot.


Your task is to:
• take a focused history
• examine the patient
• order relevant investigations
• discuss your diagnosis and management with the patient


WHAT IS THE MOST LIKELY DIAGNOSIS?:

 ACHILLES TENDON RUPTURE!!!


EXAMINATION:  (LOOK, LISTEN, FEEL !!!!):
Patient can’t “walk on toes” (tip-toe) 
Positive Thompson’s test:  (no plantar flexion of the foot with squeezing of the calf).
INVESTIGATION:

?U/S

CAUSES / RISK FACTORS:

Rheumatoid arthritis, lupus, quinolone antibiotics (ciprofloxacin), previous steroid injections in the Achilles tendon and poor athletic conditioning.

TREATMENT OPTIONS:

Non-operative:
Immobilise with splinting in plantar flexion, no weight bearing, analgesics, elevation..

Operative:

    Suturing of the Achilles tendon.

amc clinical exam