Overview Achilles tendon is a strong fibrous cord present behind the ankle that connects the calf muscles to heel bone. It is used when you walk, run and jump. When the Achilles tendon becomes thin, weak, or if it is not used, it may be susceptible to injury or damage. Achilles tendon rupture occurs most often in middle-aged athlete participating in sports that involve running, pivoting, and jumping. Recreational sports that may cause Achilles rupture include tennis, racquetball, basketball, and badminton. Causes Factors that may increase your risk of Achilles tendon rupture include Age. The peak age for Achilles tendon rupture is 30 to 40. Your sex. Achilles tendon rupture is up to five times more likely to occur in men than in women. Playing recreational sports. Achilles tendon injuries occur more often in sports that involve running, jumping and sudden starts and stops - such as soccer, basketball and tennis. Steroid injections. Doctors sometimes inject steroids into an ankle joint to reduce pain and inflammation. However, this medication can weaken nearby tendons and has been associated with Achilles tendon ruptures. Certain antibiotics. Fluoroquinolone antibiotics, such as ciprofloxacin (Cipro) or levofloxacin (Levaquin), increase the risk of Achilles tendon rupture. Symptoms Whereas calf strains and tendonitis may cause tightness or pain in the leg, Achilles tendon ruptures are typically accompanied by a popping sensation and noise at the time of the injury. In fact, some patients joke that the popping sound was loud enough to make them think they?d been shot. Seeing a board-certified orthopedic surgeon is the best way to determine whether you have suffered an Achilles tendon tear. Diagnosis The actual area of an Achilles tendon rupture cannot be seen on x-ray. Therefore, although x-rays are often done to rule out bony injuries in individuals with an Achilles tendon rupture these x-rays are usually normal. Diagnostic ultrasound of the tendon can be performed to assess the integrity of the tendon. Other diagnostic tests, such as MRI's, may also be required in difficult cases. Non Surgical Treatment Two treatment options are casting or surgery. If an Achilles tendon rupture is untreated then it may not heal properly and could lead to loss of strength. Decisions about treatment options should be made on an individual basis. Non-surgical management traditionally is selected for minor ruptures, less active patients, and those with medical conditions that prevent them from undergoing surgery. The goal of casting is to allow the tendon to slowly heal over time. The foot and ankle are positioned to bring the torn ends of the tendon close together. Casting or bracing for up to 12 weeks or more may be necessary. This method can be effective and avoids some risks, such as infection, associated with surgery. However, the likelihood of re-rupture may be higher with a non-surgical approach and recovery can take longer. Surgical Treatment Operative treatment of Achilles tendon ruptures involves opening the skin and identifying the torn tendon. This is then sutured together to create a stable construct. This can be performed through a standard Achilles tendon repair technique or through a mini-incision technique (to read about the different types of techniques, look under ?Procedure? in Achilles Tendon Repair). By suturing the torn tendon ends together, they maintain continuity and can be mobilized more quickly. However, it is critical to understand that the return to normal activities must wait until adequate healing of the tendon has occurred. The potential advantages of an open repair of the Achilles tendon include, faster recovery, this means that patients will lose less strength. Early Range of Motion. They are able to move the ankle earlier so it is easier to regain motion. Lower Re-rupture Rate. The re-rupture rate may be significantly lower in operatively treated patients (2-5%) compared to patients treated non-operatively (8-15%). The main disadvantage of an open repair of the Achilles tendon rupture is the potential for a wound-healing problem which could lead to a deep infection that is difficult to eradicate, or a painful scar.