Achilles tendon rupture Achilles tendon rupture is more common, mostly closed rupture, mostly seen in running and jumping, playing basketball, badminton and other sports, open rupture is mostly sharp cut injuries. Symptoms and diagnosis 1.Open Achilles tendon rupture caused by direct trauma The skin of the injured part is often cracked and bleeding, and the Achilles tendon tissue is sometimes visible in the wound. However, most of the patients are not easy to detect the tendon upward contraction, if inexperienced may cause a missed diagnosis. The wound is mistaken for a simple skin laceration and is only treated by debridement. On examination, the shape of the tendon disappears when the Achilles tendon is tense. The depressed and receding stump of the Achilles tendon can be palpated. 2.Achilles tendon rupture caused by indirect external force Most of the patients heard a “pop” sound at the time of injury, and felt the sensation of clubbing in the Achilles tendon or being kicked, and then felt pain and ankle movement failure in the Achilles tendon, unable to stand or walk, and pain or numbness in the gastrocnemius muscle. The gastrocnemius muscle also has pain or is accompanied by numbness and a feeling of swelling. At this time, we can find that the ankle joint is in a “resting position” where it does not dare to extend and flex automatically; the Achilles tendon disappears and sinks, and there is a depression when touched, and the pressure pain is sharp, but the subcutaneous swelling is not obvious, and mild swelling or subcutaneous bruising can be seen a little longer after the injury. The triceps pinch test is positive (Thompson test), and some patients cannot lift the heel with one foot. 3, ultrasound and MRI examination can clarify the site and degree of injury. In addition, partial rupture of the Achilles tendon is not rare in clinical practice. Do not mistake the complete rupture of the Achilles tendon but not the metatarsal tendon as a partial rupture of the Achilles tendon. Treatment Early treatment of Achilles tendon rupture should be advocated. If proper treatment is obtained early after the injury, early rehabilitation and proper training arrangements, it is not only possible to resume daily life and sports, but also completely possible to resume the original sports and reach the pre-injury training level. Non-surgical treatment In recent years, some scholars advocate the treatment of closed rupture by fixing the ankle in natural plantar flexion position with a long leg cast for 8 weeks, then removing the cast and walking with the heel padded for 4 weeks instead of surgery after Achilles tendon rupture. We believe that: non-surgical treatment can be used if surgery is not available or if the patient cannot accept surgery; otherwise, surgical treatment should be preferred. Surgical treatment Rupture of the Achilles tendon caused by direct trauma. As the severed end of the tendon is flush and the tissue defect is less, the surgical suture is easier, but the wound needs to be cleared in strict accordance with the requirements of aseptic technique before suturing, then the severed end is slightly trimmed and the Achilles tendon is directly sutured “8” to the end. However, attention should be paid to the possibility of non-healing of the incision. In closed rupture, the severed ends are uneven and horsetail-shaped, so there are difficulties in suturing, and the severed ends need to be overlapped appropriately, and if the severed ends are removed, the sutured Achilles tendon will be too short and affect the extension and flexion function of the ankle. In old Achilles tendon rupture, if the tendon defect is large, the tendon flap can be embedded in the distal broken tendon and the flap is folded into a cord. Regarding the postoperative treatment plan, the experience of our department is: postoperative long-leg cast immobilization (knee flexion angle 60°, ankle flexion angle 30°), changed to short-leg cast brace after 4 weeks, and active ankle extension and flexion activities were practiced daily in bed with the cast brace removed from the 6th week. From the 8th week, we started to walk on the ground with 3cm high and 10 layers of insoles, and we reduced one layer every 3 days for one month to resume normal walking.