Diagnosis of Achilles’ Tendon Rupture during a Virtual Examination
A 54-year-old man presented for a remote orthopedic evaluation with pain in his left lower leg. The pain had started the previous day while he was playing tennis; he had lunged to the right off of his left foot and then felt a tearing sensation in his lower left leg. He had been unable to bear weight on that leg since the time of the injury. On examination during the video consultation, the Matles test was performed. The patient was asked to lie in the prone position, flex his knees to a 90 degree angle, and relax; asymmetry of the feet with abnormal dorsiflexion of the left foot was apparent (Panel A). This finding is suggestive of a rupture of the Achilles’ tendon. Other physical-examination maneuvers to assess for Achilles’ tendon rupture, such as having the examiner squeeze the calf to assess plantarflexion, could not be performed remotely. Surgical intervention was planned, and the diagnosis of an Achilles’ tendon rupture was confirmed intraoperatively (Panel B). Tendon repair was performed, after which the patient gradually increased weight-bearing while wearing a medical boot for 6 weeks and participated in physical therapy for 3 months. At follow-up 5 months after surgery, the patient had a normal gait and improving strength and was advised to begin light jogging.