Achilles tendon rupture
Achilles tendon rupture presents with a sudden pop in the calf and a positive Thompson test, and is treated with either operative repair or functional bracing, both followed by early functional rehabilitation.
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What this article covers
- Overview
Achilles tendon rupture is a complete or partial tear of the Achilles (calcaneal) tendon, almost always occurring in a watershed zone 2 to 6 cm proximal to its insertion on the calcaneus, where blood supply is relatively poor.
- Epidemiology
Middle-aged recreational athletes ("weekend warriors") are the classic population: rupture occurs disproportionately in men in their 30s to 50s who engage in intermittent, high-intensity sport…
- Risk factors
Reduced physical conditioning before a burst of high-intensity activity: the single most consistent risk factor, a deconditioned tendon subjected to sudden eccentric load.
- Pathophysiology
Chronic intratendinous degeneration (tendinosis) precedes most ruptures: repetitive microtrauma and reduced vascularity in the watershed zone 2 to 6 cm above the calcaneal insertion produce collagen…
- Clinical features
Sudden pop or snap in the back of the calf during forceful activity, often described by the patient as feeling like being kicked or struck in the back of the leg, immediately followed by pain and difficulty walking.
- Differential diagnosis
Achilles tendinopathy (partial tear/tendinosis): chronic activity-related posterior heel pain and tendon tenderness without an acute pop, a palpable gap, or a positive Thompson test; plantar flexion strength is preserved, though painful.
- Diagnosis
Achilles tendon rupture is a clinical diagnosis confirmed by an acute pop with loss of plantar flexion strength and a positive Thompson test (no plantar flexion of the foot when the examiner squeezes…
- Management
First, immobilize the ankle in gravity-equinus (plantar flexion) with a splint or boot and refer promptly for orthopedic evaluation, since both operative and nonoperative pathways require early splinting to appose the torn tendon ends.
- Complications
Re-rupture: the most significant complication; risk is lowest with operative repair combined with early functional rehabilitation and highest with prolonged immobilization without a structured functional protocol.
- Prognosis
Most patients regain functional plantar flexion strength and return to daily activities, whether treated operatively or nonoperatively, when a structured early functional rehabilitation protocol is followed.
- Prevention
Avoid fluoroquinolone antibiotics in patients over age 60, those with a prior tendon disorder, or those on concurrent corticosteroids whenever a suitable alternative antibiotic exists.
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