Overview Achilles tendon rupture is when the achilles tendon breaks. The achilles is the most commonly injured tendon. Rupture can occur while performing actions requiring explosive acceleration, such as pushing off or jumping. The male to female ratio for Achilles tendon rupture varies between 7:1 and 4:1 across various studies. Causes A rupture occurs when a patient overstretches the Achilles tendon, an act which causes it to tear partially or completely. Achilles tendon ruptures can occur during athletic play or any time the tendon is stretched in an unexpected way. Symptoms Symptoms of an Achilles tendon injury are as follows. Pain along the back of your foot and above your heel, especially when stretching your ankle or standing on your toes; with tendinitis, pain may be mild and worsen gradually. If you rupture the tendon, pain can be abrupt and severe. Tenderness. Swelling. Stiffness. Hearing a snapping or popping noise during the injury. Difficulty flexing your foot or pointing your toes (in complete tears of the tendon). Diagnosis On physical examination the area will appear swollen and ecchymotic, which may inhibit the examiners ability to detect a palpable defect. The patient will be unable to perform a single heel raise. To detect the presence of a complete rupture the Thompson test can be performed. The test is done by placing the patient prone on the examination table with the knee flexed to 90?, which allows gravity and the resting tension of the triceps surae to increase the dorsiflexion at the ankle. The calf muscle is squeezed by the examiner and a lack of planar flexion is noted in positive cases. It is important to note that active plantar flexion may still be present in the face of a complete rupture due to the secondary flexor muscles of the foot. It has been reported that up to 25% of patients may initially be missed in the emergency department due to presence of active plantar flexion and swelling over the Achilles tendon, which makes palpation of a defect difficult. Non Surgical Treatment Your doctor may advise you to rest your leg and keep the tendon immobile in a plaster cast while it heals. Or you may need to have an operation to treat an Achilles tendon rupture. The treatment you have will depend on your individual circumstances, such as your age, general health and how active you are. It will also depend on whether you have partially or completely torn your tendon. If you have a partial tear, it might get better without any treatment. Ask your doctor for advice on the best treatment for you. If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice. Surgical Treatment Some surgeons feel an early surgical repair of the tendon is beneficial. The surgical option was long thought to offer a significantly smaller risk of re-rupture compared to traditional non-operative management (5% vs 15%). Of course, surgery imposes higher relative risks of perioperative mortality and morbidity e.g. infection including MRSA, bleeding, deep vein thrombosis, lingering anesthesia effects, etc.