Achilles tendon is the strongest tendon in the body and also the most commonly ruptured tendon in the body (1).
- disruption in the conjoined tendon of the gastrocnemius and soleus muscles occurs with rupture of the tendon
- commonly occurs 2-6 cm proximal to the tendon insertion into the calcaneus (which corresponds to a watershed region of poor vascularisation) (2).
Incidence is roughly thought to be 18 per 100,000 (3).
- incidence of Achilles tendon rupture is increasing each year.
- a Scottish cohort reported a rise from 4.7/100000 in 1981 to 6/100000 in 1994 while in a Danish cohort, incidence rose from 22.1/100000 in 1991 to 32.6/100000 in 2002
- this is thought to be due to the increasing percentage of the population participating in sporting activities at an older age
- incidence rise rapidly after the age of 25 years
- fourth or fifth decade accounts for an overwhelming majority of acute ruptures while another peak is seen between the sixth and eighth decade usually caused by longstanding degenerative condition of the tendon.
- mean age of presentation is 35 years with a male:female ratio estimated to range from 1.7:1 to 30:1 (1,3)
Risk factors for tendon ruptures include:
- increasing age
- Achilles tendonopathy
- systemic corticosteroids
- previous steroid injections into or around the Achilles tendon
- use of quinolone antibiotics (2)
Spectrum of Achilles tendon ruptures consist of:
- acute rupture - frequently seen in middle aged men (in their third and fourth decades of life) who participate in sporting activities occasionally (4)
- chronic rupture - in some patients the rupture might not be recognized at the initial presentation which will result in a delayed presentation of four to six weeks and also from overuse injuries stemming from inflammatory and degenerative changes within the tendon itself (5)
Most ruptures are seen during strenuous physical activities like playing basketball, tennis, football and softball (4).
A rupture of the Achilles tendon may be:
Reference: