[4] Rupture typically occurs as a result of a sudden bending up of the foot when the calf muscle is engaged, direct trauma, or long-standing tendonitis.

[4][5] Other risk factors include the use of fluoroquinolones, a significant change in exercise, rheumatoid arthritis, gout, or corticosteroid use.

[2] Non-surgical treatment is an alternative as there is supporting evidence that rerupture rates and satisfactory outcomes are comparable to surgery.

[5] The main symptom of an Achilles tendon rupture is the sudden onset of sharp pain in the heel.

[9] Other ways the Achilles tendon can be torn involve sudden direct trauma or damage to the tendon, or sudden use of the Achilles after prolonged periods of inactivity, such as bed rest or leg injury.

The risk continues to be higher in people who are older than 60, and also taking corticosteroids, or have kidney disease.

To perform the test, have the person lay on their stomach, face down, and with their feet hanging from the exam table.

The test is positive if squeezing the calf muscles of the affected side results in no movement (no passive plantarflexion) of the foot.

The test is negative with an intact Achilles tendon and squeezing the calf muscle results in the foot flexing down.

The person will also be unable to stand up on the toes of that leg, and pointing the foot downward (plantarflexion) is impaired.

[13] Although a tear may be diagnosed by history and physical exam alone, an ultrasound scan is sometimes required to clarify or confirm the diagnosis.

Once diagnosis is made, ultrasound imaging is an effective way to monitor the healing progress of the tendon over time.

However, when it comes to an Achilles tendon tear, an ultrasound is usually recommended first because of convenience, quick availability, and cost.

Some of these sound waves reflect back off the spaces between fluid and soft tissue or bone.

These images capture in real time and are helpful in detecting movement of the tendon and visualizing injuries or tears.

This technique uses a strong uniform magnetic field to align millions of protons running through the body.

When these protons return they emit their own unique radio waves that is analyzed by a computer in 3D to create a sharp cross sectional image of the area.

MRI provides excellent soft tissue imaging making it easier for technicians to spot tears or other injuries.

X-rays are generally best for dense objects such as bone while soft tissue is shown poorly.

[3] In centers without early range of motion rehabilitation available, surgery is preferred to decrease re-rupture rates.

[19] During an open surgery, an incision is made in the back of the leg and the Achilles tendon is stitched together.

The flexor hallucis longus tendon of the big toe is transferred with free tissue (skin flap) in a process described as a one-stage repair.

These developments hope to lessen the risk of wound complications and infections found with open surgery.

These techniques are more challenging than traditional open surgery, with a learning curve for surgeons, and are not yet widely used.

Patients that are allowed to gently move and stretch the ankle immediately after surgery, have faster and more successful recoveries.

For surgical and non-surgical patients, they will still generally limit non-weightbearing (NWB) activity to two weeks.

The runner's stretch involves putting the toes a few inches up a wall while the heel is on the ground.

Over time the goal is to include some weight bearing, to reorient and strengthen the collagen fibers in the injured ankle.

In summary, the steps of rehabilitating a ruptured Achilles tendon begin with range of motion type stretching.

[25] The rate of return to sports in the months or years following the rupture (whether operated on or not, partial or total) is 70 to 80%.