[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Conditions](https://durgical.com/en/conditions/) › Achilles tendon rupture [Conditions](https://durgical.com/en/conditions/) · [Lower limb](https://durgical.com/en/anatomy/region/lower-limb/) # Achilles tendon rupture An [Achilles tendon](https://durgical.com/en/anatomy/calcaneal-tendon/) rupture is a tear of the big tendon above the heel; it often feels like a kick to the calf and makes pushing off weak. Updated 2026-10-29 ## Structures involved Tap one to see what it is and open it in 3D. - [Gastrocnemius (inner head)](https://durgical.com/en/anatomy/medial-head-of-gastrocnemius/) - [Gastrocnemius (outer head)](https://durgical.com/en/anatomy/lateral-head-of-gastrocnemius/) - [Soleus](https://durgical.com/en/anatomy/soleus-muscle/) - [Calcaneus](https://durgical.com/en/anatomy/calcaneus/) - [Plantaris](https://durgical.com/en/anatomy/plantaris-muscle/) - [Heel bursae](https://durgical.com/en/anatomy/subtendinous-calcaneal-bursa/) - [Sural nerves](https://durgical.com/en/anatomy/sural-nerve/) - [Flexor hallucis longus](https://durgical.com/en/anatomy/flexor-hallucis-longus/) - [Tibial nerve](https://durgical.com/en/anatomy/tibial-nerve/) ## In the clinical exam - [Thompson test](https://durgical.com/en/clinical-exam/thompson-test/) ## Why it happens - [Collagen](https://durgical.com/en/biochemistry/enzymes/collagen/) - [Connective tissue proper: cells and fibres](https://durgical.com/en/histology/connective-tissue-proper-cells-and-fibres/) ## What it is A partial or complete tear of the Achilles tendon, the common tendon of the gastrocnemius and [soleus](https://durgical.com/en/anatomy/soleus-muscle/) that inserts on the [calcaneus](https://durgical.com/en/anatomy/calcaneus/), usually a few centimetres above the heel. ## Who gets it Typically affects middle-aged adults who play sport occasionally ("weekend athletes"), more often men. Football and racquet sports are common settings. ## Causes - Sudden push-off with the knee straight - Unexpected forced dorsiflexion of the ankle - Violent dorsiflexion of a plantar-flexed foot, e.g. a fall from height ## Risk factors - Pre-existing Achilles tendinopathy - Fluoroquinolone antibiotics - Systemic or local corticosteroids - Intermittent sport without conditioning - Older age and male sex - Inflammatory and metabolic diseases (e.g. gout, chronic [kidney](https://durgical.com/en/anatomy/kidney/) disease) ## Pathophysiology The tendon's mid-portion has a relatively poor blood supply, a watershed area where degeneration builds up. A sudden eccentric load on a weakened tendon makes the fibres fail, most often 2–6 cm above the insertion. The torn ends can retract, and plantar flexion strength falls. ## Classification - Acute or chronic (missed, neglected) rupture - Partial or complete - By site: mid-substance, insertional, musculotendinous junction ## Symptoms and signs - Sudden pain in the back of the heel, often like being kicked or hit - A pop or snap at the moment of injury - Weak push-off; difficulty walking on tiptoe or climbing stairs - Swelling and bruising above the heel - A palpable gap in the tendon ## Red flags - Calf swelling and pain out of proportion (rule out deep vein thrombosis or compartment syndrome) - A missed diagnosis: plantar flexion by other muscles can mask the rupture ## Diagnosis **Clinical** Thompson test (squeezing the calf does not move the foot), palpable gap, increased resting dorsiflexion compared with the other side (Matles test). Clinical diagnosis is usually reliable. **Tests** Usually none. **Imaging** Ultrasound confirms the tear and measures the gap; MRI if unclear or chronic. X-ray excludes calcaneal avulsion. ## Differential diagnosis - Achilles tendinopathy or partial tear - Medial gastrocnemius strain ("tennis leg") - [Plantaris](https://durgical.com/en/anatomy/plantaris-muscle/) rupture - Deep vein thrombosis - Calcaneal avulsion fracture - Ankle fracture ## Goal of treatment Heal the tendon at the right length and tension to restore push-off strength, with the least re-rupture and complication risk. ## Treatment **Conservative** Non-operative care: a boot or cast with the foot pointed down, then gradually brought up, with early functional rehabilitation. **Surgical** Surgical repair (open or minimally invasive) is often offered to active patients; it may lower re-rupture risk but adds wound and nerve risks. Evidence varies. **Surgical** Chronic ruptures may need reconstruction, for example a [flexor hallucis longus](https://durgical.com/en/anatomy/flexor-hallucis-longus/) tendon transfer. **Rehabilitation** Structured rehabilitation for range of motion, calf strength and return to sport over months. ## Complications - Re-rupture - Tendon healing elongated, with weak push-off - Wound infection or breakdown after surgery - [Sural nerve](https://durgical.com/en/anatomy/sural-nerve/) injury - Deep vein thrombosis during immobilisation ## Prognosis Most patients return to walking and many to sport, but full recovery takes months and some calf weakness may persist. ## Prevention - Gradual conditioning before sport - Caution with fluoroquinolones and corticosteroids, especially in older adults ## Test yourself Think of the answer, then tap the question to see it. ## How is the Thompson test performed and what is a positive result? With the patient prone, the examiner squeezes the calf. In a complete rupture the foot does not plantar-flex. ## Where does the Achilles tendon usually rupture? In the relatively poorly perfused mid-portion, roughly 2–6 cm above its insertion on the calcaneus. ## Which antibiotic class is associated with Achilles tendon rupture? Fluoroquinolones, especially in older adults and with corticosteroid use. ## Why can a patient with a complete rupture still plantar-flex the foot weakly? Other muscles (tibialis posterior, long toe flexors, fibularis muscles) can still plantar-flex, which can mask the diagnosis. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/conditions/achilles-tendon-rupture/) ## Related conditions - [Achilles Tendinopathy](https://durgical.com/en/conditions/achilles-tendinopathy/) - [Deep vein thrombosis](https://durgical.com/en/conditions/deep-vein-thrombosis/) - [Ankle fracture](https://durgical.com/en/conditions/ankle-fracture/) Educational information, not medical advice. For any symptom, see a health professional. Sources: [Achilles Tendon Rupture](https://www.ncbi.nlm.nih.gov/books/NBK430844/) (StatPearls (NCBI Bookshelf), 2023). [← All conditions](https://durgical.com/en/conditions/) ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/conditions/achilles-tendon-rupture/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/achilles-tendon-rupture/