Contributor: Aaron Lessen, MD Educational Pearls: Achilles tendon rupture usually presents in younger, healthy patients after a sports injury Patients typically present complaining of an abrupt onset ankle pain after feeling a “pop” Pain can be localized to posterior ankle and patient’s lack the ability to plantarflex Achilles rupture is a clinical diagnosis and does not usually require imaging in the ED Thompson test Having patient lay on their stomach and squeezing the calf on the injured side should result in plantarflexion  If the Achilles is ruptured, no plantarflexion will occur Treatment in the ED is to place the patient in a short leg posterior splint with some mild plantarflexion to aid in healing After discharge patients should follow up with orthopedics Recent study compared those who underwent the traditional open surgery, a minimally invasive surgery, and no surgery No difference in functionality was noted between the groups 3 months to 1 year post injury Those in the nonoperative group had slightly higher rates of repeat rupture (6%) than those in the surgical groups (<0.6% in each) Patients undergoing minimally invasive surgery had the highest risk of nerve injury (5.2%), followed by traditional surgery (2.8%), and then nonoperative (0.6%) References Cuttica DJ, Hyer CF, Berlet GC. Intraoperative value of the thompson test. J Foot Ankle Surg. 2015;54(1):99-101. Kauwe M. Acute Achilles Tendon Rupture: Clinical Evaluation, Conservative Management, and Early Active Rehabilitation. Clin Podiatr Med Surg. 2017;34(2):229-243. Myhrvold SB, Brouwer EF, Andresen TKM, et al. Nonoperative or Surgical Treatment of Acute Achilles' Tendon Rupture. N Engl J Med. 2022;386(15):1409-1420.   Summarized by Mark O’Brien, MS4 | Edited by John Spartz MD & Erik Verzemnieks, MD   The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account.  Donate to EMM today!