American Podiatric Medical Association

View all recommendations from this society

August 1, 2017

Avoid ordering MRI in patients with suspected acute Achilles tendon ruptures.

MRI is expensive and can lead to treatment delays. History and physical exam findings can establish the diagnosis of acute Achilles tendon ruptures in nearly all instances. Physicians should reserve MRI for atypical presentations and subacute or neglected ruptures when preoperative planning is needed. When physicians prefer to use the rupture gap (i.e., apposition of tendon ends) as criteria for management (surgery versus conservative treatment), dynamic ultrasound can be easily substituted.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American Podiatric Medical Association’s (APMA) Clinical Practice Advisory Committee, consisting of APMA members, board members, young members and liaisons with special interests in a variety of subspecialty areas within podiatric practice, formulated the recommendations for the ABIM Foundation’s Choosing Wisely Campaign. The Committee worked with podiatric colleagues to create an initial list of recommendations, which was reviewed and narrowed down to eight recommendations. The list of eight recommendations was further developed and distributed to the Committee for ranking in numerical order. Committee members were asked to rank the recommendations based on their relevance, timeliness, strength of supporting evidence and appropriateness for inclusion in the Choosing Wisely Campaign. The rankings and deliberation enabled the Committee to come to the final five recommendations, which were again reviewed to ensure appropriate evidence was used to support each recommendation. The final recommendations were approved by the Board of Trustees of the APMA before submission to the ABIM Foundation. APMA’s disclosure and conflict of interest policy can be found at


Singh D. Acute Achilles tendon rupture. BMJ. 2015;351:h4722.

Garras DN, Raiken SM, Bhat SB, Taweel N, Karanjia H. MRI is unnecessary for diagnosing acute Achilles tendon ruptures: clinical diagnostic criteria. Clin Orthop Relat Res. 2012;470:2268-73.

Wallace RG, Heyes GJ, Michael AL. The non-operative functional management of patients with a rupture of the tendo Achillis leads to low rates of re-rupture. J Bone Joint Surg Br. 2011;93:1362–66.