Achilles Rupture

Blausen Medical · Wikimedia Commons · CC BY 3.0

Achilles tendon rupture is a complete disruption of the tendon, most commonly occurring 2–6 cm proximal to the calcaneal insertion in the relatively avascular mid-substance. The classic mechanism is a sudden forceful plantarflexion — pushing off to sprint, jumping, or stepping into a pothole — often described as feeling like being kicked in the back of the leg. Most patients report a loud "pop."

Rupture is most common in the "weekend warrior" — deconditioned men in their 30s–50s who engage in sudden bursts of activity. Prior steroid injections and fluoroquinolone antibiotics are risk factors.

The Thompson test is the key exam: with the patient prone and knees bent, squeezing the calf should plantarflex the foot — absence of plantarflexion confirms a complete rupture. A palpable gap above the heel and inability to perform a single-leg heel rise support the diagnosis. Ultrasound confirms the rupture and gap size. MRI is used preoperatively for complex cases.

Operative repair is preferred in young, active, and athletic patients who want the fastest reliable return to sport. Non-operative treatment is a reasonable alternative for lower-demand patients or those with medical contraindications to surgery.

External patient-education references and related OSI pages for additional background:

• Britannica — Tendon
• Britannica — Ankle (anatomy)
• AAOS OrthoInfo — patient education library
• OSI glossary — orthopedic terminology in plain language