Achilles tendon rupture refers to the loss of continuity of the tendo Achillis, usually from attrition.

Injury often occurs during an activity that puts great stress on the tendon. Sudden “pop” is often felt followed by weakness and swelling.
• Patient walks flat-footed and is unable to stand on the ball of the foot.
• Tenderness and hemorrhage are present at the site of injury, and a sulcus is usually palpable but may be obscured by an organizing clot if the examination is delayed.
• Although active plantar flexion is usually lost, some plantar flexion occasionally remains because of the activity of the other posterior compartment muscles.
• Thompson’s test is usually positive. Test measures plantar flexion of the foot when the calf is squeezed with the patient kneeling on a chair; normal foot plantarflexes with calf compression, but movement is absent when tendo Achillis is ruptured.
• Excessive passive dorsiflexion of the foot is also present on the injured side ( Fig. 1–10 ).

• Relative hypovascularity predisposing to tendon rupture in several tendons (Achilles, biceps, and supraspinatus)
• With advancing age, vascular supply to the tendon further compromised
• Repetitive trauma leading to degeneration of this critical area and weakness
• Rupture of tendo Achillis usually 2.5 to 5 cm from the insertion of the tendon into the os calcis
• Most common causative event leading to rupture: sudden dorsiflexion of the plantar flexed foot (landing from a height) or sudden pushing off with the weight on the forefoot

DIFFERENTIAL DIAGNOSIS
• Incomplete (partial) tendo Achillis rupture
• Partial rupture of gastrocnemius muscle, often medial head (previously thought to be “plantaris tendon rupture”)
WORKUP
• Clinical diagnosis of tendo Achillis rupture is usually obvious.
• If bony injury is suspected, plain roentgenograms are indicated.
• Other studies are usually unnecessary.

• Early referral is necessary for surgical repair.
• If surgery is contraindicated, a short leg cast applied with the foot in equinus may allow healing.
• In cases of neglected rupture, reconstruction is usually indicated.
DISPOSITION
• Prognosis for recovery after surgical repair of the acute rupture is good, but recurrence is not uncommon regardless of treatment.
• Tendo Achillis must be protected from excessive activity for up to 1 yr.
• Results of reconstruction for neglected cases are worse than with primary repair.

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Wong J, Barrass V, Maffulli N: Quantitative review of operative and nonoperative management of Achilles tendon ruptures, Am J Sports Med 30(4):565, 2002.