Abstract
Background:
The purpose of this study was to characterize trends and public interest of Achilles tendon ruptures (ATRs) between 2013 and 2023 in the United States utilizing Google Trends data to evaluate how patients seek information on ATRs online.
Methods:
Using Google Trends health category for the United States and worldwide through a 10-year period (January 1, 2013, to December 31, 2023), these search terms were queried: Achilles, Achilles tendon, Achilles tendon injury, Achilles tear, Achilles tendon rupture, Achilles repair, Achilles surgery, and Achilles rupture recovery.
Results:
Several Achilles-related search terms demonstrated significant increases in interest in the United States, including Achilles, Achilles tendon, Achilles tear, Achilles repair, and Achilles surgery (all P ≤ .038). Worldwide, similar increases were seen, although aggregate global trends were not statistically significant.
Conclusion:
Public interest in Achilles tendon injuries significantly increased over the past decade in the United States, with a parallel rising trend worldwide. The greatest peaks in interest were corresponded with high-profile injuries, indicating the influence of media on public awareness. These trends suggest that patients are actively seeking information online, particularly regarding treatment options and outcomes. As such, these findings highlight the importance of meeting this demand through the creation of accurate and accessible online educational content about ATRs.
Level of Evidence:
Level IV.
Introduction
The Achilles tendon is the largest, strongest, and thickest tendon in the body that endures immense daily load and even more force when sustaining a rupture.7,17 As the most commonly ruptured tendon, injury incidence is continually increasing, with risk factors being related to male sex, mechanical overload, advancing age, fluoroquinolone use, improper footwear, and uneven terrain, among several other variables that can increase susceptibility.8,11,13,20 Achilles tendon ruptures (ATR) are often seen in healthy and active populations, although they may occur in those older and less physically active.9,13 Primarily, these injuries occur during sudden and forceful plantarflexion, resulting in a rupture most commonly 3 to 4 cm proximal to the calcaneal insertion.1,10,24 Annually, 18 per 100 000 individuals are reported to sustain an ATR, a number that has increased over the past several decades. 12 This more commonly occurs in males, as well as those between the ages of 37 and 43.1,10,13,18,22,24 Additionally, basketball and racquetball comprise more than half of the ATRs in the United States.1,10,18
Public interest of ATRs can be gauged through the assessment of internet search volume data. Google Trends (Mountain View, CA) is an open-access tool that monitors online search volumes and has been previously used to evaluate public interest in several disciplines of health care.6,23 In orthopaedics, Google Trends has been used in various contexts, such as assessing interest in platelet-rich plasma injections, hip and knee osteoarthritis, and the impact of the COVID-19 pandemic on interest in treatment for common hand pathologies.4,5,16 Similar public interest in ATR has yet to be reported, and it is of value to determine if patients are using the Google search engine online to obtain information related to this pathology and its treatment. With the rising incidence in Achilles pathologies, it is of interest to explore the online search patterns surrounding Achilles rupture. The purpose of this study was to characterize trends and public interest of Achilles tendon ruptures between 2013 and 2023 in the United States using Google Trends data to evaluate how patients seek information on ATRs online.
Materials and Methods
Google Trends
This study evaluated aggregate scores from Google Trends specifically assessing ATR. Because of the publicly available nature of these data, institutional review board approval was not necessary.
Searches were collected in February 2024 through the Google Trends health search query feature, localizing to the United States. Specific “search terms” were searched rather than “search topics,” to allow for the collection of various forms of the same term to be included in the same popularity score. For example, the use of AT as a search term would aggregate results for both “AT” and “Achilles Tendon.” After a keyword is entered, a chart is produced illustrating the relative frequency of that volume over a defined period. Each term received a relative search volume (RSV) value ranging from 0 to 100, in which 0 indicated the lowest public interest and 100 the highest. 3
Search Queries
Search terms were selected based on previous Google Trends analyses that used keywords describing common and medical terms for various pathologies.2,5,21 The following terms were searched for the analysis: Achilles, Achilles tendon, Achilles tendon injury, Achilles tear, Achilles tendon rupture, Achilles repair, Achilles surgery, and Achilles rupture recovery. Data were obtained from January 1, 2013, to December 31, 2023. Weekly RSV scores were collected for interest over time and then adjusted to allow for regression analyses. Searches were completed independently by 2 authors with any discrepancies reviewed by a senior author.
Geographic Trends
Public interest by geographic region was evaluated. RSV was obtained for each state that populated over the stated 10-year period.
Statistical Analysis
The analysis for this study was performed using RStudio 2022.02.0 (RStudio Team, PBC, Boston, MA). For assessment of temporal trends, linear regression models were performed for each search term alone in addition to an average model of all search terms to understand ATR interest. Subsequent accuracy measures such as multiple R2, mean absolute deviation (MAD), mean square error (MSE), and mean absolute percentage error (MAPE) were calculated for the aggregate simple linear regression models. Qualitative analysis for geographic trends was performed using Microsoft Excel to illustrate national and international ATR search interest. For all quantitative statistical analyses, significance was set at P <.05.
Results
Distribution of Terms Over the 10-Year Period
Simple linear regression models performed for the average of all ATR-related search terms in the United States and worldwide are represented in Figures 1 and 2, respectively. US interest over time demonstrated a significant increasing temporal trend over the 10-year period (P = .003) including accuracy measures of MAD of 6.28, MSE of 101.84, and a MAPE of 16.66%. Worldwide interest demonstrated a similar increasing trend; however, it was statistically nonsignificant (P = .068). Accuracy measures for this model included a MAD of 3.95, MSE of 54.86, and a MAPE of 10.17%. Both models demonstrated low trendline approximation R2 values with 0.066 and 0.025, respectively. Notable peaks were observed in search interest in April of 2013, June of 2019, and September of 2023.
Linear trend model for Achilles rupture search interest in the United States over 10 years.
Linear trend model for Achilles rupture search interest worldwide over 10 years.
Geographic Trends
The list of search terms used in this analysis along with each respective simple linear regression P value, multiple R2, and temporal trend designation can be found in Table 1. Of the terms included, Achilles, Achilles tendon, Achilles tear, Achilles repair, and Achilles surgery, each demonstrated statistically significant increasing trends in the United States (P = .011, .038, .001, <.001, <.001). Worldwide, the following 4 terms, Achilles, Achilles tear, Achilles repair, and Achilles surgery, each demonstrated statistically significant increasing trends (P = <.001, .004, <.001, <.001). R2 values for these trends range from 0.033 to 0.317.
List of Search Terms With 10-Year Temporal Trends in the United States and Worldwide
Boldface indicates significance.
Illustration of ATR search interest in the United States between 2013 and 2023 is demonstrated in Figure 3. Gray indicated no search interest recorded, lighter shades indicated low RSV, and darker shades indicated high RSV as delineated in the bottom left corner of the figure. In the United States, Montana and Vermont held the highest ATR RSV, each at 100, with Louisiana and North Dakota ranking the lowest, each with an RSV of 40. Worldwide, Iceland had the highest RSV at 100, the United States tied for fifth at 42, and several nations held a low RSV of 0.
Achilles tendon rupture search interest by US state between 2013 and 2023.
Discussion
This study aimed to quantify online public interest in Achilles tendon ruptures over a 10-year period using Google Trends data. The results showed a general increase in US search interest over time for several Achilles-related terms, with inconsistent but sometimes parallel trends worldwide. Notably, spikes in interest corresponded to injuries of high-profile athletes, suggesting that public attention is partly driven by media coverage of professional sports figures. However, the temporary spikes in interest during these periods indicates this public engagement may be episodic and event-driven rather than sustained.
Patients frequently use source on the Internet to obtain additional information related to their diagnoses and treatment, often both before and after visits with their physician. 14 With the incidence of ATRs increasing throughout the past several decades in addition to significant media coverage, it is reasonable to expect a rise in public interest in these pathologies.12,19 The findings of this study demonstrated that Achilles-related search terms significantly increased in interest over the past 10 years in the United States and worldwide, demonstrating that as incidence in ruptures has risen, so has public interest. Interestingly, the search term Achilles tendon rupture did not show a significant increase in interest, although Achilles surgery and Achilles repair did. Patients may seek out simpler search terms rather than searching the exact diagnosis or medical jargon. These findings also likely indicate a greater search volume among the public in treatment and treatment outcomes rather than diagnosis. The production of patient education materials on these topics that contains easily understood information regarding ATR operative treatment and rehabilitation can provide patients with a needed resource.
Varied geographical trends were observed in the present study. Montana and Vermont demonstrated the highest RSV, in contrast to Louisiana and North Dakota who had the lowest. Whether this trend can be correlated to interest is challenging to determine as 3 of 4 states do not fall within those with the highest or lowest median income levels. 26 Cohen et al 5 completed a Google Trends analysis assessing interest in platelet-rich plasma injections for osteoarthritis, specifically comparing geographic interest between the 5 states with the highest median income to the lowest median income. Their study showed greater growth in interest in the highest-income states, an unsurprising finding given the often costly nature of these treatments. Further studies are needed to fully understand motives behind the search traffic in relationship to geographic tendencies.
In an era of widespread internet accessibly, patients increasingly turn to online resources to seek information about their medical conditions, potential treatments, and expected outcomes. 25 This trend underscores the evolving role of the internet, and Google, as a key source of health information. However, although there is a vast quantity of health-related content available, accuracy of this information is variable. Inaccurate or incomplete online content may lead to misconception, misguided treatment expectations, distrust in physicians, and increased anxiety. 15 Consequently, the need for reliable, evidence-based, and accessible patient education materials becomes exceedingly more critical. Our findings, which highlight a sustained increase in search interest for Achilles tendon–related search terms over the past decade reinforce the observation that patients actively seek information about this injury and its management online. Notably, searches related to treatment (ie, Achilles surgery and Achilles repair) demonstrated significant growth suggesting that patients may prioritize understanding treatment options. Clear, accessible content—written at an appropriate reading level without medical jargon—that addresses patient concerns and explains treatment plans may bridge the gap between clinical care and patient understanding. In addition, leveraging digital platforms to deliver these resources may be valuable in enhancing patient engagement and improving adherence.
Limitations
This study has several limitations. Google Trends does not provide demographic data on users or their motivations, limiting inferences about the underlying drivers of search behavior. The tool reflects only searches conducted via Google, which—although dominant—does not capture 100% of internet activity. In addition, online search volume may not directly correlate with disease incidence, health-seeking behavior, or medical literacy. Finally, although some temporal trends were statistically significant, the low R² values suggest considerable variability, limiting the predictive strength of the regression models.
Conclusion
Public interest in Achilles tendon injuries significantly increased over the past decade in the United States, with a parallel rising trend worldwide. The greatest peaks in interest were corresponded with high-profile injuries, indicating the influence of media on public awareness. These trends suggest that patients are actively seeking information online, particularly regarding treatment options and outcomes. As such, these findings highlight the importance of meeting this demand through the creation of accurate and accessible online educational content about ATRs.
Supplemental Material
sj-pdf-1-fao-10.1177_24730114251371667 – Supplemental material for Public Interest in Achilles Tendon Ruptures: A 10-Year Google Trends Analysis
Supplemental material, sj-pdf-1-fao-10.1177_24730114251371667 for Public Interest in Achilles Tendon Ruptures: A 10-Year Google Trends Analysis by Hayden Hartman, Christopher Rennie, Benjamin C. Murray and Arianna L. Gianakos in Foot & Ankle Orthopaedics
Footnotes
Ethical Approval
This study was exempt from ethical approval.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Arianna L. Gianakos, DO, reports general disclosures of paid consultant for Arthrex, Inc, paid consultant for Conmed, board or committee member for American Orthopaedic Foot & Ankle Society and the Ruth Jackson Orthopedic Society. All the other authors have no relevant financial or nonfinancial interests to disclose. Disclosure forms for all authors are available online.
References
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
