Rupture of the Achilles tendon may be idiopathic, but often one or more risk factors are present. To prevent the initial episode, and more importantly to prevent a recurrence, identification of risk factors with correction of modifiable factors is necessary.
Exercise and trauma:
(1) strenuous, impact-loading athletic activities
(2) repetitive and cumulative microtraumas from shoes or at work
(3) sedentary lifestyle followed by excessive exercise
(4) obesity associated with heavy exercise
(5) immobilization followed by disuse atrophy
(6) blunt trauma
(7) burns
Steroid-related:
(1) anabolic hormone use
(2) corticosteroids
(3) cirrhosis (alcoholic, hemochromatosis, Wilson's disease, etc.) with estrogenic excess
Metabolic and hormonal:
(1) hyperparathyroidism
(2) diabetes mellitus
(3) renal insufficiency
(4) gout
Drug-related:
(1) fluoroquinolones
Autoimmune disease:
(1) rheumatoid arthritis
(2) spondyloarthropathy, including patients with HLA-B27
(3) connective tissue disease with vasculitis
Vascular:
(1) peripheral vascular disease
Infection:
(1) syphilis
(2) osteomyelitis in calcaneus
(3) infectious vasculitis
