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Achilles tendinopathy and tendon rupture

Karen L Maughan, MD
Section Editor
Karl B Fields, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM


Pain of the Achilles tendon commonly affects both competitive and recreational athletes, and the sedentary. The largest tendon in the body, the Achilles tendon, endures strain and risks rupture from running, jumping, and sudden acceleration or deceleration. Overuse, vascular diseases, neuropathy, and rheumatologic diseases may cause tendon degeneration. The hallmarks of Achilles tendon problems seem to be damaged, weak, inelastic tissue.

This topic review will discuss the mechanism, diagnosis, and management of Achilles tendinopathy and tendon rupture. A general discussion of treatments for tendinopathy is provided separately. (See "Overview of the management of overuse (chronic) tendinopathy".)


Tendonitis, tendinosis, tendinopathy, paratendonitis, enthesopathy, and insertional tendonitis are among the terms used to characterize acute or chronic tendon pain. The common term tendonitis is confusing because inflammation is often not seen on histopathology. Throughout this review, we will use the term tendinopathy to refer to acute and chronic pain associated with an Achilles tendon injury other than tendon tear or rupture. (See "Overview of overuse (chronic) tendinopathy", section on 'Pathology and terminology: tendinosis versus tendinitis'.)


Achilles tendinopathy affects competitive and recreational athletes as well as people who are not active [1]. The incidence of Achilles tendon rupture in the general population is approximately 5 to 10 per 100,000, but may be higher in some regions and populations, and increasing overall [2-5]. Over 80 percent of ruptures occur during recreational sports. Approximately 10 percent of patients who sustain an Achilles tendon rupture had preexisting Achilles tendon problems [6].

Observational data suggest that competitive athletes have a lifetime incidence of Achilles tendinopathy of 24 percent, with 18 percent sustained by athletes younger than 45 years [7]. Tendon rupture occurs in 8.3 percent. Among competitive runners, the lifetime incidence of Achilles tendinopathy may be as high as 40 to 50 percent.

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Literature review current through: Nov 2017. | This topic last updated: Feb 23, 2017.
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