Achilles Tendon Ruptures: The Scourge of the Mid-Life Male Athlete

May 19, 2016

by Kevin R. Stone, M.D.

Achilles tendons must have been rupturing since the time of Achilles. How else would every 40- 60-year-old male weekend warrior (and a number of pro basketball players) have learned to recognize and dread that classic gunshot sound of the tendon snapping?

The Achilles tendon connects the muscles of the calf to the calcaneus, or heel bone. It is designed to stretch. This serves to absorb force as an athlete lands from a jump, and to deliver power to the foot in walking and running [1]. The tendon tissue is flat, with a good blood supply, and serves most women well for their entire lifetime [2]. Why does it vex men in the fourth and fifth decades, and why is the repair so troublesome?

The answer, like most in medicine, is multifactorial—an awful word that means “many contributing causes.” Men traditionally play ballistic sports, at levels beyond what their fitness might warrant, well into their later years. A testosterone- driven competitive edge pushes them to leap higher, land harder and lunge further, going for that shot that is just out of reach. Their risk factors seem clear.

But what about women athletes? It’s not fully understood. Though women are often also super fit, they are less likely than men to rupture their Achilles. According to one study, the Achilles tendons of women may be more elastic than those of men, which may contribute to their reduced incidence of tearing [3].

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