Rupture Spontanee Du Tendon D’achille Sur Terrain Diabetique : A Propos Du Cas

Abstract

Achilles Tendon Rupture (ATR) is a frequently described lesion in sports traumatology. It can occur following certain chronic or systemic diseases. We reported a case of a 48-year-old woman, a teacher by profession, who was consulting for lameness. Anamnesis found during a walk, a brutal sensation of blow on the heel with cowardice and sharp pain at the elective point imposing upon the resting of the patient. Clinical examination noted an increased spontaneous dorsiflexion of the affected ankle, depression corresponding to the tendon continuity solution, and a positive Thompson test. The diagnosis of Achilles Tendon Rupture was made. The patient was operated 2 weeks later by open surgery. A simple suture kept by a plaster splint was performed (the ankle in equinus). Functional rehabilitation was done for 6 weeks, and walking was allowed at the 6th week. In the absence of minimally invasive surgery, conventional surgery can provide good results in case of spontaneous Achilles Tendon Rupture at the cost of rigorous monitoring of the patient.European Scientific Journal February 2018 edition Vol.14, No.6 ISSN: 1857 -7881 (Print) e -ISSN 1857-7431 296 Keywords: Achilles tendon, Thompson's test, rupture of the tendon RésuméLa rupture du tendon d'Achille (RTA) est une lésion fréquente en pathologie du sport. Elle peut survenir suite à certaines maladies chroniques ou systémiques. Nous rapportons le cas d'une femme âgée de 48 ans, enseignante, qui consultait pour boiterie. L'interrogatoire retrouvait à l'esquisse d'une marche, une sensation brutale de coup sur le talon avec lâchage et douleur vive au point électif imposant la mise au repos de la patiente. L'examen clinique montrait une dorsiflexion spontanée augmentée de la cheville atteinte, une dépression correspondant à la solution de continuité du tendon et un test de Thompson positif. Le diagnostic de rupture de tendon d'Achille était posé. La patiente était opérée 2 semaines après par une chirurgie à ciel ouvert. Une suture simple maintenue d'une attelle plâtrée a été réalisée, la cheville en équin. Une rééducation fonctionnelle était faite pendant 6 semaines. La marche était autorisée à la 6 ème semaine. À défaut de la chirurgie mini-invasive, la chirurgie classique peut donner des résultats satisfaisants en cas de RSTA au prix d'un suivi rigoureux du patient.

Clinical and therapeutic aspects of Achilles tendon ruptures at Kara University Hospital (Togo)

“…Acute ruptures of the Achilles tendon frequently occur during high-level or leisure sports activities [1,2,9] . These lesions may also occur in underlying pathological conditions and constitute a particular type of degenerative rupture [9,10] . These two lesion entities are found in our series.…”

“…This major stress, linked to a loss of its viscoelastic properties with age, is responsible for a large proportion of its pathology, and in particular ruptures which most often occur in weakened tendons with degenerative histological lesions [11] . In addition to physiological changes in the tendon and chronic overload with microtrauma, degeneration can also result from hormonal, systemic and metabolic diseases such as diabetes mellitus, systemic lupus erythematosus, hypercholesterolaemia and obesity, rheumatism and gout [9,10,12] . Certain drugs such as corticosteroids and fluoroquinolones also present a risk of tendon rupture when administered over a long period [12,13] .…”

“…He feels as if he has been "Hit From Behind". The pain is immediate and sudden, and it also subsides very quickly [10,14] . When there is an underlying pathology, mechanical pain of moderate intensity and variable duration often precedes the lameness [15] .…”

“…When there is an underlying pathology, mechanical pain of moderate intensity and variable duration often precedes the lameness [15] . In all cases, the physical signs are identical, namely loss of equinus of the foot in prone position, feet protruding from the examination table (Brunet Guedj's sign), depression along the tendon path and a positive Thompson's sign [6,10,15] . In acute ruptures, an x-ray of the ankle can be used to diagnose cases of calcaneal avulsion of the tendon insertion, and to rule out other bony lesions in the region, such as bimalleolar fractures and other calcaneal fractures.…”