What causes Achilles tendon rupture?
A normal Achilles tendon is unlikely to rupture. Usually, there is a pre-existing tendinopathy (tendon disease). This tendinopathy is often not painful prior to the rupture. And not all painful tendinopathies rupture. As with other muscle, tendon or ligament insertion site problems (enthesopathies), Achilles tendinopathy is most common in middle-aged people (those ages 35 to 60). Athletes sometimes develop tendinopathy or rupture in their late 20s or early 30s. Patellar tendon, quadriceps and Achilles tendon ruptures are generally problems of an athlete near the end of their professional career (e.g. Kobe Bryant, Tony Parker, etc.).

Is surgery necessary for an Achilles tendon rupture?
Rupture of the Achilles tendon can be treated operatively or nonoperatively. The tendon heals when immobilized with the foot pointed toward the ground (plantarflexion). This can be done in with a removable splint, with weight-bearing and with graduated motion exercises. Surgery adds risks of infection and wound problems, but is felt by some to speed recovery and limit re-rupture. Studies have shown similar outcomes between patients treated with and without surgery, including similar rates of re-rupture, which is uncommon in general.

What is the prognosis?
It can be very difficult to return to the same level of play after an Achilles tendon rupture.