5. A poorly conditioned 40-year-old man started to play squash, particularly on

Question

5. A poorly conditioned 40-year-old man started to play squash, particularly on the weekends. During a game, he felt pain in his calcaneal tendon, followed by calf pain. The pain went away and he continued to play squash vigorously. After a few minutes the calf pain returned, followed by an audible snap. He then had difficulty tiptoeing and climbing stairs, but found it easy to dorsiflex his ankle. What do you think caused the audible snap? What caused the calf pain? (2) a. b. What physical sign would you expect to observe? (1) Why did he have trouble tiptoeing and climbing stairs? (1) c. Why was it still possible for him to dorsiflex his ankle? Name one muscle that contributes to this action. (2) d. e. What is the distal attachment (insertion) of the calcaneal tendon? (1)

Explanation / Answer

A). The audible snap is caused by rupture of calcaneal tendon (or Achilles tendon rupture). It connects (calf muscles) soleus and gastrocnemius to calcaneus bone of foot. The calf muscle pain is due to excessive stretch, partial tear and rupture of tendon Achilles.

B). Following physical signs may be elicited

C). Tiptoeing require Plantar flexion of foot, this is achieved by calf muscle which act on foot via Achilles tendon. If it gets ruptured then there will be difficulty in Plantar flexion therefore tiptoeing becomes difficult

D). Dorsiflexion is done by anterior group of muscle while plantar flexible is down by calf muscle, therefore dorsiflexion is unaffected (as the injury is in tendon of calf muscle)

E). The distal attachment of calcaneal tendon is on calcaneal tuberosity of cancaneus bone

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