Achilles tendon rupture

Achilles tendon rupture is the breakage of the Achilles tendon at the back of the ankle.^[5] Symptoms include the sudden onset of sharp pain in the heel.^[3] A snapping sound may be heard as the tendon breaks and walking becomes difficult.^[4]

Rupture of the Achilles tendon usually occurs due to a sudden, forceful push-off movement, an abrupt dorsiflexion of the foot while the calf muscle is engaged, or direct trauma. Chronic degeneration of the tendon, often from tendinosis, also increases the likelihood of rupture. Common risk factors include fluoroquinolone or corticosteroid use, sudden increases in physical activity, inflammatory conditions such as rheumatoid arthritis, gout, and chronic overuse or improper training. Diagnosis is primarily based on clinical symptoms and physical examination, with imaging such as ultrasound or MRI used for confirmation when needed.^[7]

Prevention may include stretching before activity and gradual progression of exercise intensity.^[4] Treatment may consist of surgical repair or conservative management.^[6][2] Quick return to weight bearing (within 4 weeks) appears acceptable and is often recommended.^[6][7] While surgery traditionally results in a small decrease in the risk of re-rupture, the risk of other complications is greater.^[2] Non-surgical treatment is an alternative as there is supporting evidence that rerupture rates and satisfactory outcomes are comparable to surgery.^[2] If appropriate treatment does not occur within 4 weeks of the injury outcomes are not as good.^[8]

The incidence of Achilles tendon ruptures varies in the literature, with recent studies reporting a rate of up to 40 patients per 100,000 patient population annually.^[9] The significant increase in ruptures this past decade is thought to be linked to the increased number of individuals engaging in sporting activities, particularly adults older than 30. During recreational sports, 75% of ruptures occur in men between the third and fourth decades of life.^[9]