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Spontaneous rupture of the Achilles tendon can occur in patients in their 20's to 40's. Rupture is more common in men than women and most injuries occur during sporting activities. The most common mechanism of injury is pushing off forcefully such as in tennis, squash, racquetball, and basketball.

When the Achilles tendon ruptures, the person often hears a "pop" or "snap" at the time of injury and feels a sudden pain in the region of the Achilles tendon. However, the pain subsides quickly. There is weakness when trying to stand on tiptoes. A defect or gap in the Achilles tendon can usually be felt.

Treatment Options

After the diagnosis of an Achilles rupture is made, a decision is made to treat nonoperatively or operatively. Despite which route is elected recovery can be extensive, with predictable return to push off sports such as running to be on average about 6 months.

Non-surgical Treatment
Non-Surgical treatment involves a period of cast immobilization, with the toes pointing down to allow the torn Achilles tendon can heal, followed by progression to protected weightbearing and a PT program.

Benefits of non-surgical treatment are that it avoids potential complications associated with surgery, such as infections and wound breakdown. However, there is a higher re-rupture rate with cast treatment, there is less pushing-off strength and less endurance when compared to tendons that have been surgically repaired.

Surgical Treatment
Surgical repair of Achilles tendon ruptures consists of sewing together the torn ends. A major advantage of early repair is that early range of motion out of cast can be allowed.

Benefits of surgical repair of the Achilles tendon are a lower re-rupture rate (0-4%), a greater chance of returning to sports, greater strength, and more endurance. Post-operative rehabilitation consists of a cast for two weeks, then a removable cast-boot for about 8 weeks after surgery.