An Achilles tendon rupture is a complete or partial tear that occurs when the tendon is stretched beyond its capacity. Jumping, violent pivoting, or sudden acceleration during running, a fall can stretch the tendon and cause a tear.

The Achilles tendon is formed by a coalescence of fibres from the gastrocnemius and soleus muscles. This complex crosses the knee and ankle joints, making it more susceptible to injury than muscles that cross a single joint.

What causes Achilles tendon rupture?

  • Older age
  • Activities or sports that involve running and jumping
  • Lack of flexibility
  • Excessive activity (overuse)
  • Sudden changes in exercise intensity
  • Poor conditioning
  • Use of corticosteroids (by mouth or by injection)
  • Ill-fitting shoes
  • Jogging or running on hard surfaces
  • Climb or step of stairs
  • Previous Achilles tendon injury
  • Family history
  • Organic disorder
    • Diabetes
    • Renal failure
    • Rheumatoid arthritis
    • Systemic lupus erythematosus (SLE, lupus)
    • Gout

What are the symptoms of Achilles tendon rupture?

  • Although it is possible to have no signs or symptoms with a ruptured Achilles tendon, most people have:
  • The feeling of having been kicked in the calf
  • Pain, possibly severe and swelling near the heel
  • An inability to bend the foot down or “push back” the injured leg when walking
  • An inability to stand on the toes of the injured leg
  • A clicking or clicking noise when the injury occurs

Foot problems that increase the risk of Achilles tendon injuries include:

  • Pied cavus
  • Insufficient flexibility and strength of the gastrocÅ“lian
  • limited ability to dorsiflex the ankle
  • Tibia vara
  • Varus alignment with functional hyperpronation

Risk factors

  • Age. The maximum age of Achilles tendon rupture is 30 to 40 years.

  • Sex. Achilles tendon rupture is up to five times more likely to occur in men than in women.

  • Recreational sports. Achilles tendon injuries are more common in sports that involve running, jumping, and sudden starts and stops – such as football, basketball and tennis.

  • Steroid injections. Doctors sometimes inject steroids into an ankle joint to reduce pain and inflammation. However, this medication can weaken nearby tendons and has been linked to Achilles tendon ruptures.

  • Obesity. Being overweight puts more strain on the tendon.

Differential diagnosis

  • Achilles tendonitis
  • Ankle sprain
  • Peroneal tendonitis
  • Tendonitis of the posterior tibia or tendonitis of the flexor of the big toe.
  • Fracture of the calcaneus or ankle.
  • Muscle tear of the gastrocnemius muscle.

Therapy

  • Plantar flexion splint
  • Immediate referral to an orthopedist
  • Sometimes surgical repair

References

  1. Järvinen TA, Kannus P, Maffulli N, Khan KM. Achillestendon disorders: etiology and epidemiology. Foot Ankle Clin. 2005 Jun;10(2):255-66. [PubMed]
  2. Carmont MR. Achillestendonrupture: the evaluation and outcome of percutaneous and minimally invasive repair. Br J Sports Med. 2018 Oct;52(19):1281-1282. [PubMed]
  3. Noback PC, Freibott CE, Tantigate D, Jang E, Greisberg JK, Wong T, Vosseller JT. Prevalence of Asymptomatic Achilles Tendinosis. Foot Ankle Int. 2018 Oct;39(10):1205-1209. [PubMed]
  4. Haapasalo H, Peltoniemi U, Laine HJ, Kannus P, Mattila VM. Treatment of acute Achillestendonrupture with a standardised protocol. Arch Orthop Trauma Surg. 2018 Aug;138(8):1089-1096. [PubMed]
  5. Yasui Y, Tonogai I, Rosenbaum AJ, Shimozono Y, Kawano H, Kennedy JG. The Risk of AchillesTendonRupture in the Patients with Achilles Tendinopathy: Healthcare Database Analysis in the United States. Biomed Res Int. 2017;2017:7021862. [PMC free article] [PubMed]
  6. Alušík Š, Paluch Z. [Drug induced tendon injury]. Vnitr Lek. 2018 Winter;63(12):967-971. [PubMed]
  7. Ahmad J, Jones K. The Effect of Obesity on Surgical Treatment of AchillesTendon Ruptures. J Am Acad Orthop Surg. 2017 Nov;25(11):773-779. [PubMed]
  8. Egger AC, Berkowitz MJ. Achillestendon injuries. Curr Rev Musculoskelet Med. 2017 Mar;10(1):72-80. [PMC free article] [PubMed]
  9. Maffulli N, Via AG, Oliva F. Chronic AchillesTendonRupture. Open Orthop J. 2017;11:660-669. [PMC free article] [PubMed]
  10. Dams OC, van den Akker-Scheek I, Diercks RL, Wendt KW, Zwerver J, Reininga IHF. Surveying the management of Achillestendon ruptures in the Netherlands: lack of consensus and need for treatment
  11. Credit in part: Alan G. Shamrock; Matthew Varacallo.

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