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Achilles tendon rupture: how to avoid missing the diagnosis.

Over recent months, the authors of this paper have seen an increase in the number of patients with a delayed or missed diagnosis of ruptured Achilles tendon presenting to their orthopaedic clinics. Many subscribe to the view that any delay in diagnosis of more than 24 hours is a relative indication for surgery. In a recent review of negligence claims in foot and ankle surgery, it was shown that delayed or missed diagnosis of ruptured Achilles tendon represented the third highest claim, with an average of £56 900 per case.1

Rupture of the Achilles tendon is a common injury, with approximately 4500 patients seeking medical help every year in the UK.2–4 Most cases of Achilles tendon rupture are traumatic sports injuries. The typical age of patients is 29–40 years with a male-to-female ratio of nearly 20:1.

A sudden pain in the back of the leg, with an audible snap, is the classic story in Achilles tendon rupture. Patients will often think that they have been hit directly in the calf; it is very rare for there to be prior symptoms from the tendon.

### Points to remember