The Achilles tendon is the largest tendon in the human body and provides the attachment of the converged soleus and gastrocnemius muscles to the calcaneus. Achilles tendon ruptures often result from indirect trauma related to sports and exercise and primarily affect men between the ages of 30–50 years. Pre-existing degenerative conditions and certain drugs (e.g., local glucocorticoid injections) have been linked with an increased risk of complete or partial Achilles tendon rupture. Patients may experience a sudden onset of sharp pain in the tendon at the back of the ankle, usually accompanied by a popping or snapping sound or sensation. A positive Thompsons test may be followed by an ultrasound or MRI to confirm the Achilles tendon rupture. Both conservative and surgical treatments are recommended. Surgical treatment is associated with a lower risk of Achilles tendon re-rupture. However, complications linked to surgery, such as infection and hemorrhage, must be taken into consideration.
- Anatomy of the Achilles tendon
- Mechanism of injury
- Risk factors
- Popping or snapping sound/sensation when the injury occurs
- Sudden, severe pain in the Achilles tendon
- Difficulty mobilizing: loss of plantar flexion power on the affected side
- Deformity: calf swelling; (e.g., hematoma) and/or palpable interruption of the affected Achilles tendon
- Clinical tests
- Thompson test: squeezing the calf (e.g., gastrocnemius muscle) of the patient, in the prone position with legs extended
- Hyperdorsiflexion sign: the patient sits prone with knees flexed to 90°; both feet are passively dorsiflexed maximally.
- O'Brien needle test: a needle is inserted 10 cm proximal to the calcaneal insertion of the Achilles tendon; the foot is passively dorsiflexed.
- Mainly a clinical diagnosis
- Imaging is indicated to evaluate the extent of the injury and/or to exclude other suspected pathologies.
Both conservative and surgical approaches are recommended, but the indications for conservative vs surgical treatment are controversial.
- Conservative therapy
- Surgical therapy
- Excellent prognosis with early treatment
- Repair of complicated cases (e.g., following re-rupture) has a poorer outcome.