Achilles Tendon Rupture

Aka: Achilles Tendon Rupture

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II. Definitions

  1. Achilles Tendon Rupture
    1. Spontaneous heel cord rupture

III. Epidemiology

  1. More common in men aged 30 to 50 years
  2. More common with sedentary lifestyle, when sudden or repetitive movement is introduced
  3. Spontaneous ruptures are related to sports in more than two thirds of cases
  4. Sports commonly involved
    1. High Jump
    2. Basketball
    3. Football
    4. Softball

IV. Pathophysiology

  1. Uncommon injury
  2. Results from tendon degeneration or excessive force
  3. Rupture site
    1. Os calcis (2.5 - 5 cm from tendon insertion)

V. Symptoms

  1. Injury from great stress on tendon (e.g. jumping)
  2. Patient hears "pop" at heel with injury
  3. Often with severe sudden acute pain
    1. Pain may initially be mild

VI. Signs

  1. Patient walks Flatfooted
    1. Most plantar flexion lost
    2. Excessive passive dorsiflexion of foot
    3. Unable to stand on ball of foot
  2. Localized tenderness achilles tendon insertion
  3. Localized Hemorrhage at rupture site
  4. Sulcus palpable at rupture site
    1. May be obscured by organizing clot
  5. Thompson's Test abnormal (no plantar flexion)

VII. Imaging

  1. Ruptured achilles tendon may be diagnosed clinically without imaging
  2. Musculoskeletal Ultrasound
    1. Test Sensitivity: 94.8%
    2. Test Specificity: 98.7%
    3. Aminlari (2021) J Emerg Med 61(5): 558-67 [PubMed]

VIII. Diagnosis

  1. Exercise high level of suspicion
  2. Initially missed diagnosis in 20-30% of Achilles Tendon Ruptures

IX. Differential Diagnosis

  1. See Heel Pain
  2. Partial Gastrocnemius Tear
  3. Achilles Tendonitis
  4. Plantaris Rupture
  5. Tibial Stress Fracture
  6. Deep Vein Thrombosis

X. Management

  1. Orthopedic Consultation in all cases
  2. Surgical repair for young athletes
    1. Followed by immobilization for 6-8 weeks
  3. Non-operative Management (Immobilization)
    1. Indications for non-operative management (immobilization only)
      1. Older patients or less active (esp. with presentations within 72 hours of injury)
    2. Efficacy
      1. Similar outcomes with faster recovery than surgery
        1. Weber (2003) Am J Sports 31:685-91 [PubMed]
    3. Initial Immobilization for at least 4 weeks (historically 8-12 weeks)
      1. Short Leg Walking Cast or cam walker
        1. Foot in mild equinus (plantar flexion)
      2. Non-weight bearing (Crutches) for at least 2-3 weeks
      3. Immobilize for 8-12 weeks
        1. May be as short as 4 weeks in some protocols
    4. Stabilization and Physical Therapy for 6 weeks
      1. Stabilization in ankle-foot Orthosis or heel wedges
      2. Physical therapy
    5. Adjunctive Measures
      1. Platelet Rich Plasma Injections

XI. Prognosis

  1. Recurrent Achilles Tendon Rupture is common
  2. Protect from excessive activity for 1 year
  3. Competitive athletes should expect decreased function
  4. Re-rupture rate
    1. Immobilization only: 13.4%
    2. Surgical repair: 1.4%
    3. Lo (1997) Clin J Sport Med 7:207-11 [PubMed]

XII. References

  1. Feldsher (2023) Crit Dec Emerg Med 37(3): 20-1
  2. Greene (2001) Musculoskeletal Care p.420-1
  3. Mazzone (2002) Am Fam Physician 65(9):1805-10 [PubMed]
  4. Morancie (2025) Am Fam Physician 112(6): 648-56 [PubMed]
  5. Yang (2018) Bone Joint Res 7(10):561-69 +PMID: 30464836 [PubMed]

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