INTRODUCTION​

• The achilles tendon is the strongest tendon in the body and the primary plantar flexor of the ankle 

• The incidence of achilles ruptures is 18 per 100,000 persons

• Patients may continue to have active ankle plantarflexion due to the action of other flexors of the ankle. As a result, diagnosis is initially missed 25% of the time

• Achilles rupture can occur high, near the muscle–tendon juncture (9%), at the tendon midportion (72%), or at the calcaneal insertion (19%)

• Most Achilles ruptures do not have any antecedent symptoms

• Tendinosis may play a role, but the extent of this role remains unknown

• Men are 12 times more likely than women to rupture their achilles tendon

• From an epidemiologic standpoint, middle-aged men with white-collar professions and recreational athletic activity constitute most of the patients

• Other predisposing factors are leg muscle imbalance, training errors, foot pronation, and use of corticosteroids and fluoroquinolones

• The contralateral risk of rupture was estimated at 26% on return to the same level of sports activities

CAUSES​

• Achilles ruptures are usually caused by noncontact injuries

• Common injury mechanisms leading to Achilles rupture are forceful push-off with an extended knee, sudden unexpected ankle dorsiflexion, or violent dorsiflexion of a plantarflexed foot

SIGNS AND SYMPTOMS

• Patients with achilles tears often complain of a pop in the back of the ankle. Some even think that someone kicked them in the back of the ankle

• They often report tenderness to palpation, swelling, and weakness with walking

TREATMENT​​

• Treatment consists of non-operative vs. operative

• Nonoperative treatment entails casting the foot in plantarflexion to allow apposition of the tendon ends, followed by casting the foot in neutral. Treatment for 12 weeks

• Nonoperative treatment is often reserved for elderly, sedentary patients and also for patients with diabetes, tobacco use, and steroid use who are at high risk for surgical wound healing problems

• Surgical treatment involves repairing the tendon ends together using a mini-open incision

PREVENTION  ​​

• Maintaining a stretched and loose achilles can help decrease the chance of rupturing the achilles tendon