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September 30th 2021

Medical Negligence

Delay in diagnosing 76-year-old woman’s Achilles tendon rupture shows importance of carrying out Simmonds’ test

Emma Stone

Emma Stone

Solicitor, Clinical Negligence

Delay in diagnosing 76-year-old woman’s Achilles tendon rupture shows importance of carrying out Simmonds’ test

The case of a 76-year-old woman whose recovery from a ruptured Achilles tendon was hindered because of a delayed diagnosis has highlighted the importance of carrying out the Simmonds’ test.

The case of a 76-year-old woman whose recovery from a ruptured Achilles tendon was hindered because of a delayed diagnosis has highlighted the importance of carrying out the Simmonds’ test.

A medical negligence claim against the NHS alleged there had been a missed opportunity to carry out the Simmonds’ test during one of our clients’ GP appointments.

According to the British Journal of General Practice, a rupture of the Achilles tendon is a common injury, with more than 4,000 patients seeking medical help every year in the UK.

It also says that the Simmonds’ test, first described in 1957 by Franklin ‘Sam’ Simmonds to test for an Achilles tendon rupture, “should be understood and remembered by all medical and physiotherapy practitioners”.

Why do Achilles tendon ruptures occur and what is the Simmonds’ test?

A consultant orthopaedic surgeon instructed to produce a medical expert report in this case provided the following background during the medical negligence claim.

He said: “Achilles tendon ruptures occur in tendons that have a degree of degeneration within them. They are typically a forced push-off injury, i.e. there is forced plantar flexion of the ankle against resistance, this leads to contraction of the gastrocnemius muscle and the tendon is caught in between and ruptured.

“It is described as the sensation of being kicked from behind. Patients often report hearing a crack.

“One can walk after a rupture of the Achilles tendon. Although they can be painful, weight bearing is still feasible as is ankle movement.

“Diagnosis is made based upon the clinical history, but also examination findings of a tender area, there may be a dip palpable where the tendon ends have separated, or there may be weakness of tip-toe standing.

“But the diagnostic test is the Simmonds’ test, where the patient is either kneeling or lying flat on their front with the ankle dependant, the calf muscle is gently squeezed and if movement occurs this indicates that the tendon is intact.”

How should an Achilles tendon rupture be treated?

The expert noted that treatment of Achilles tendon ruptures, if diagnosed within 10 days, can often be treated conservatively either in a plaster or a walking boot with the ankle in plantar flexion – i.e. pointing downwards.

The injury can also be treated with an operation, with the window of opportunity for surgery around six weeks after the rupture to suture the tendon ends together – which he said has “an excellent functional outcome of a 90-95% recovery”.

Beyond the six-week mark, it is often the case that “revision surgery is required and this has a reduced functional outcome”.

Meanwhile, whilst a lot of Achilles tendon ruptures are complete, partial ruptures do occur and also require treatment and investigation to confirm whether it is a minor partial rupture which can be treated quite simply or a significant partial rupture which requires a period of immobilisation and protection while it heals.

The expert also added: “One also has to point out that not all Achilles tendon ruptures are a simple straightforward snap. The Achilles tendon is akin to a packet of spaghetti with multiple strands running through it, they do not all rupture at the same level but at varying levels.”

Woman makes claim for delayed diagnosis compensation

According to the British Journal of General Practice, most cases of ruptured Achilles tendons are traumatic sports injuries, and the typical age is between 29 and 40.

However, these tears are not uncommon in elderly patients, as seen by the then 76-year-old woman who was represented in a claim against the NHS by Emma Stone, Solicitor in the Clinical Negligence team at Hudgell Solicitors.

“My client injured her left ankle and subsequently attended hospital where she was reassured and referred to her GP,” said Ms Stone.

“On her first attendance at her GP, a Simmonds’ test was performed and showed there to be no rupture. Unfortunately, her pain worsened so she returned to her GP, but no Simmonds’ tests was performed and the client was treated for tendonitis.

“A month later, my client returned to see a different GP and a further Simmonds’ test was performed and this showed a rupture.

“It was alleged that had the Simmonds’ test been undertaken at the previous appointment, the rupture would have been present, and a diagnosis made.”

This case, in which Ms Stone managed to secure £6,500 compensation for her client, highlights the wide variety of different claims our expert medical negligence lawyers work on every day at Hudgell Solicitors.

If you believe you may have a claim for medical negligence then you can contact us for free, no obligation advice about your case. Click here to get in touch >> 

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