Achilles tendon rupture – a diagnosis not to be missed

The Achilles tendon (AT) is the largest tendon in the human body, connecting the gastrocnemius, soleus and plantaris muscles to the calcaneus. Together with these muscles, the AT causes plantarflexion of the foot at the ankle joint and flexion at the knee, which are vital functions within the gait cycle. The AT also prevents excessive dorsiflexion of the foot. Whilst AT rupture presentations are more commonly seen in the emergency department, it is still frequently seen in general practice, particularly delayed presentations and missed diagnoses. This is anticipated to increase further, especially following the recent COVID-19 pandemic and as people return to sport following a lengthy lay-off. Despite an awareness of the seriousness of this injury, many clinicians are unaware of how it presents and how best to manage the patient. This article will focus on the aetiology of AT ruptures, as well as explaining how they present to general practice and how best to examine the patient clinically suspected to have sustained this injury.