to the editor: The article in American Family Physician on conditions of the Achilles tendon1 points out that the frequency of ruptures is increasing as more people exercise. The high rate of ruptures that go undiagnosed or mis-diagnosed should alert physicians to this condition in patients who present with ankle and leg complaints suggestive of tendon injury. The desirability and importance of early, correct diagnosis and prompt treatment is clearly seen by information that delayed diagnosis and subsequent improper (in misdiagnosed cases) or delayed treatment (longer than one month) can result in less functional recovery in some patients.2
As stated in the article, most ruptures of the Achilles tendon occur during physical activities, especially those involving certain movements that place stress on the tendon and promote rupture. Three categories of indirect injury that may result in rupture are: (1) pushing off with a weightbearing forefoot while also extending the knee, as occurs at the beginning of a sprint, running, and some forms of jumping; (2) sudden and unexpected dorsiflexion of the ankle, which may occur when a person slips off a chair or a ladder, when stumbling into a hole, or suddenly falling forward; and (3) violent dorsiflexion of a plantar-flexed foot when one falls from a height.3,4
Although future improvements in surgical and nonsurgical treatments will undoubtedly benefit patients with a ruptured Achilles tendon, the efficacy of treatment in maximizing the functional recovery of strength, power, endurance, and mobility of the ankle joint and calf muscles (gastrocnemius and soleus) will be limited if injury to the tendon goes unnoticed or is misdiagnosed. Careful history taking of events before the injury and a complete physical examination of the foot, ankle, and leg are generally adequate to diagnose rupture. Because the incidence of rupture is expected to increase, physicians need to become more adept at diagnosing Achilles tendon ruptures, so that patients may realize the maximum benefit from available treatment options.