title: Achilles tendon rupture must be excluded in the neutral, non-fractured ankle X-ray study.
abstract: BACKGROUND
  Rupture of the Achilles tendon (TA) is a common injury. Nevertheless, there is significant potential for missing the diagnosis on initial presentation. We investigated the potential role of lateral ankle X-ray studies in aiding diagnosis.
  
  
  OBJECTIVE
  To determine the potential role of radiographs of the ankle in assisting in the diagnosis of Achilles tendon ruptures.
  
  
  METHODS
  In a regional trauma unit, 27 patients with confirmed TA rupture at operation had the "tibio-first metatarsal angle" measured as an indication of ankle neutrality. A neutral ankle was defined as an angle of≤100°. Twenty-seven patients with intact TA were used as controls.
  
  
  RESULTS
  The mean angle in the TA rupture group was 88° (range 70-120°) and 125° (104-146°) in the control group (p<0.001).
  
  
  CONCLUSIONS
  In cases of TA rupture, the ankle adopts a more dorsiflexed position than in the ankle with an intact TA. We believe that an ankle joint adopting a neutral position on a lateral X-ray study of the ankle provides a clue to help reduce the rate of missed TA ruptures at initial presentation.
authors.affiliation: Department of Trauma and Reconstructive Surgery, Our Lady of Lourdes Hospital, Drogheda, Co Louth, Ireland.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Kiely
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Baker
authors.forename: D Lim
authors.initials: DL
authors.lastname: Fat
authors.forename: Grainne
authors.initials: G
authors.lastname: Colgan
authors.forename: Anthony
authors.initials: A
authors.lastname: Perera
authors.forename: Nassir
authors.initials: N
authors.lastname: Awan
authors.forename: Jimmy
authors.initials: J
authors.lastname: Colville
mesh_terms: D000125:Achilles Tendon / Q000000981:diagnostic imaging / Q000293:injuries*; D000208:Acute Disease; D000328:Adult; D000368:Aged; D016512:Ankle Injuries / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013708:Tendon Injuries / Q000000981:diagnostic imaging*