Achilles tendon rupture: a challenging diagnosis.

Since the 1950s the incidence of spontaneous complete rupture of the Achilles tendon has risen steadily, possibly as a result of increased sedentary lifestyles and intermittent participation in recreational sports.1 Today the Achilles tendon is the second most frequently ruptured tendon, and no other tendon suffers complete rupture more often.3 Up to 25% of all cases are misdiagnosed,4-6 with serious consequences for the patient. Family physicians must be able to recognize acute Achilles tendon ruptures to initiate expedient treatment and referral. The overwhelming majority of cases can be diagnosed using only findings from the history and physical examination. The following case illustrates common pitfalls encountered when evaluating Achilles tendon injuries.