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When Achilles rupture occurs, there is sudden debilitating pain.  Patient’s often report feeling as though someone had thrown a rock at their calf or having been shot, which can sometimes be heard at the time of injury.  It is possible that one could walk post rupture, but would not be able to walk on their toes.


Rupture is most common in older athletes between the ages of 30 and 50, with men more affected.  The tendon ruptures under excessive load.  Factors which can contribute are tight Achilles and calf muscles, hypomobile joints in the foot and ankle, training terrain and intensity, shoes which are inflexible and poor shock absorbers, and a rigid and/or over-pronating foot type.  Repeated steroid injections or prolonged steroid intake can also predispose tendons to weakness.  




By squeezing the calf (Thomson’s test) the foot should plantarflex.  If no movement is detected, rupture should be suspected.  It must be noted however there are other muscles that plantarflex the foot.  


There are 2 options for management depending on the orthopaedic specialist’s recommendation.  Typically, age and the person’s level of physical activity are considered.  Alternately, there is a non-surgical option, which involved casting.  Both options will require intense rehabilitation and physiotherapy management.  


A physiotherapist or doctor should be able to perform the Thomson test accurately.  Also, a defect or gap may be able to be felt on palpation of the Achilles tendon. Immediate referral for further investigation will be warranted followed by assessment and management by an orthopaedic specialist.  Post surgery/immobilisation your physiotherapy will ensure that you regain your pre-injury level of movement, strength and function.  Treatment will include, manual therapy, stretches, gradual strengthening and gait re-education.


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