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Achilles Tendon Tears

By Danielle Campagne, MD , Assistant Clinical Professor, Department of Emergency Medicine, University of San Francisco - Fresno

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Achilles tendon tears (ruptures) most often result from ankle dorsiflexion, particularly when the tendon is taut. Diagnosis is by examination and sometimes ultrasonography or, if unavailable, MRI. Treatment is splinting and immediate referral to an orthopedic surgeon; sometimes surgical repair is necessary.

Achilles tendon tears are common. They typically occur during running or jumping and are most common among middle-aged men and athletes. Very rarely, spontaneous Achilles tendon tears have occurred in people who take fluoroquinolone antibiotics.

Pain in the distal calf makes walking difficult, particularly when the tear is complete. The calf may be swollen and bruised. Complete tears may result in a palpable defect and usually occur 2 to 6 cm proximal to the tendon's insertion.


  • Clinical evaluation

  • Sometimes ultrasonography or, if unavailable, MRI

Diagnosis is by examination. The patient's ability to flex the ankle does not rule out a tear.

For the Thompson test (calf squeeze test), the calf is squeezed to elicit plantar flexion while the patient is prone; results may include

  • For complete tears: Absent or decreased ankle plantar flexion

  • For partial tears: Sometimes normal results, so these tears are often missed

If the Thompson test is normal but a partial Achilles tendon tear is suspected, ultrasonography is the test of choice. However, if ultrasonography is not available, MRI can be done.


  • Splinting

  • Immediate orthopedic referral

  • Sometimes surgical repair

Initial treatment consists of splinting with the ankle in plantar flexion and immediate referral to an orthopedic surgeon.

Whether tendon tears should be treated surgically is controversial.

Treatment may involve a posterior ankle splint with the ankle in plantar flexion for 4 wk and avoidance of weight bearing.

Some complete tears are surgically repaired immediately.

* This is the Professional Version. *