07/04/2026
Achilles ruptures are rising — but it’s probably not just because more people play sport.
The picture looks broader than that.
Medication exposure matters. Fluoroquinolone antibiotics have a well-established association with tendon rupture, and the risk increases with age, corticosteroid use, and renal impairment. This isn’t obscure pharmacology — it’s in UK and EU drug safety guidance.
Metabolic health likely plays a role too. Conditions like diabetes and obesity are increasingly linked with poorer tendon biology, and rising rates of these conditions at a population level may be contributing to weaker tendons across the board. The evidence for hyperlipidaemia and thyroid disorders is more emerging, but it’s part of the conversation.
Then there’s the loading picture. A lot of Achilles ruptures happen in people who are active enough to compete but not consistently prepared for what that demands — minimal training through the week, high-intensity sport on the weekend, sudden sprinting and jumping loads on tendons that haven’t been progressively exposed to them.
Finally, some of the rise is probably better detection. The 2026 review acknowledges this directly — improved awareness, imaging access and more consistent diagnosis across health systems will capture cases that previously went unrecorded.
The key point: Achilles rupture risk is multifactorial. Good rehabilitation has to account for more than just the tendon itself.
📄 Kotsifaki R, Malliaras P, Byron C et al. Sports Med (2026). DOI: 10.1007/s40279-026-02397-5 + supporting literature.