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Foot and Ankle

Achilles Rupture

What is an Achilles Tendon Injury?

An Achilles tendon rupture often happen during  eccentric loading of the Achilles tendon.  This often happens playing tennis, basketball, or other sports that require backpedaling.  Patients usually described a pop and pain in the heel.  Patients often state they feel as if they were kicked in the posterior ankle.  Rupture of the Achilles tendon involves pain and decreased push off strength.  Injuries can happen in a “weekend warrior” or a high-level athlete.  There is an association with oral antibiotic use, specifically fluoroquinolones.


Patients with an Achilles tendon rupture complain of pain in the posterior ankle as well as decreased strength pushing off during gait.  Some patients are unable to walk at all.  Some patients retain the ability to flex the ankle with the use of the flexor hallucis longus as well as flexor digitorum longus muscles.

How to Diagnose an Achilles Tendon Injury

A thorough evaluation after an Achilles tendon rupture is important.  The diagnosis can usually be made clinically, needing without the use of advanced imaging modalities such as MRI.  The patient usually has a palpable gap at the area of the Achilles tendon rupture.  Occasionally, the tendon ruptures off its insertion on the calcaneus–termed an insertional rupture.  A Thompson test is utilized to confirm the diagnosis of an Achilles tendon rupture.  The test is done by lying a patient on their belly and squeezing the calf.  If the tendon is intact, there is gentle plantar flexion of the foot.  If the tendon is ruptured, there is no motion of the foot.  X-rays are occasionally indicated.  The x-rays are used to check that there has been no avulsion, or pulling up, of the calcaneus.

At a Glance

Dr. Brian Waterman, MD

  • Chief & Fellowship Director, Sports Medicine, Wake Forest
  • Team Physician, Wake Forest University, Chicago White Sox
  • Military affiliation/Decorated military officer and surgeon
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