Achilles tendon #

Remember analgesia.Always assess and record the patient's ability to bear weight


  • "Snap" at ankle / calf (textbook = painful, often not!)
  • Reported at "push off" during sport
  • Beware - may be the initial trigger (hidden) for "twisted" ankle

Ask about

  • Steroid or Quinolone use
  • Rheumatoid arthritis
  • SLE
  • Renal failure
  • Hyperparathyroidism
  • Hyperlipoproteinaemia
  • Gout


  • Cannot toe weight bear on that side
  • Observe # foot may not rest in natural plantar-flexion
  • Palpable step in Achilles Tendon
  • Thompson test - lie prone and calf squeeze produces plantar flexion in normal individuals
  • Matles test - lie prone, knees flexed 90°, gravity makes # side ankle more dorsiflexed


  • Server's (calcaneal apophysitis) in teenagers
  • Peroneal tendonopathy or dislocation
  • Retrocalcaneal bursa, Os trigonum syndrome
  • Ankle OA, Systemic arthritis (check other side)
  • Sural neuroma (or referred pain from sacral roots)



  • Refer to on call orthopaedic team
  • Operative repair is preferable to conservative management [Bestbets].(NNT=10, NNH=21 [Bandolier])
  • If conservative Mx consider prophylactic anticoagulation (LMWH) particularly if high risk of VTE or prior DVT.[BestBets]
Kuwada's classification
Type 1: <50% tear Cast for 8 weeks
Type 2: defect < 3cm Surgical anastimosis
Type 3: defect 3-6 cm Anastimosis or graft
Type 4: defect >6cm
(incl. delayed repairs)
Tendon graft


In patients immobilised in leg casts:

  • Consider prophylactic anticoagulation (Rivaroxaban or LMWH).[BestBets]
  • CUH EM and Orthpaedic divisions have (Feb 2013) reviewed the literature (including the 2012 Oct CEM guideline). Prophylactic anticoagualtion is not required those pateints discharged in a splint but should be considered in all in PoP
  • Achilles # patients in equinus PoP are particularly prone to VTE

Content by Dr Íomhar O' Sullivan 14/03/2004.  Reviewed by Dr ÍOS 06/01/2005, 17/07/2005, Dr Chis Luke 17/07/2005, ÍOS 08/02/2007. Last review Dr ÍOS 21/06/21.