Acute Achilles tendon rupture

#### What you need to know While playing tennis, a healthy 35 year old man felt as though he had been hit on the back of the lower leg by his opponent’s racquet. He couldn’t keep playing but could walk. He presents the next day with mild bruising, swelling, and weakness while walking. He can walk on tip toes but Simmonds’ triad (calf squeeze, altered angle of declination, and palpable gap) confirms the diagnosis of a ruptured Achilles tendon. A rupture of the Achilles tendon (fig 1⇓) is a disruption in the conjoined tendon of the gastrocnemius and soleus muscles, usually about 2-6 cm proximal to the tendon insertion into the calcaneus.1 Risk factors include increasing age, Achilles tendonopathy, systemic corticosteroids, previous steroid injections into or around the Achilles tendon, and use of quinolone antibiotics.1 2 Fig 1 On opening the paratenon at surgery, the two ends of a complete transverse rupture of the Achilles tendon, with an intervening gap (arrow), are seen. The plantaris tendon is intact (arrowhead) #### How common is acute Achilles tendon rupture?