An Achilles tendon rupture is a tear of the tendon that connects your calf muscles to your heel bone. Achilles tendon rupture is a common injury that usually happens while playing sport or doing exercise. If you rupture your Achilles tendon, you’ll find it difficult to walk, run, climb stairs or stand on tiptoe.
Achilles Tendon Ruptures are common tendon injuries that occur due to sudden dorsiflexion of a plantarflexed foot, most commonly associated with sporting events.
The Achilles tendon is at the back of the heel. It can be ruptured by sudden force on the foot or ankle. If your Achilles tendon is ruptured you will be unable to stand on tiptoe and will have a flat-footed walk. It is important to diagnose and treat this injury as soon as possible, to help promote healing. Treatment involves wearing a plaster cast or brace (orthosis) for several weeks, and possibly having an operation.
An Achilles Tendon Rupture is a common, usually spontaneous rupture in the Achilles Tendon, often observed in people aged between 24-45 years. In most cases, the rupture occurs between 3-6 cm above where the tendon meets the heel bone. Ruptures in the Achilles Tendon usually happen when there is a forceful movement of the foot against resistance (typically heel facing downwards). An example of this happening would be someone pushing their feet with great force to jump, or from using gym equipment improperly.
What Is Achilles Tendon Rupture?
- The Achilles tendon, or calcaneal tendon, is a large ropelike band of fibrous tissue in the back of the ankle that connects the powerful calf muscles to the heel bone (calcaneus).
- Sometimes called the heel cord, it is the largest tendon in the human body.
- When the calf muscles contract, the Achilles tendon is tightened, pulling the heel. This allows you to point your foot and stand on tiptoe. It is vital to such activities as walking, running, and jumping.
- A complete tear through the tendon, which usually occurs about 2 inches above the heel bone, is called an Achilles tendon rupture.
What Causes A Ruptured Achilles Tendon?
As with any muscle or tendon in the body, the Achilles tendon can be torn if there is a high force or stress on it. This can happen with activities which involve a forceful push off with the foot – for example, in football, running, basketball, diving and tennis. The push off movement uses a strong contraction of the calf muscles which can stress the Achilles tendon too much.
The Achilles tendon can also be damaged by injuries such as falls, if the foot is suddenly forced into an upward-pointing position – this movement stretches the tendon. Another possible injury is a deep cut at the back of the ankle, which might go into the tendon.
Sometimes the Achilles tendon is weak, making it more prone to rupture. Factors that weaken the Achilles tendon are:
- Corticosteroid medication (such as prednisolone) – mainly if it is used as long-term treatment rather than a short course.
- Corticosteroid injection near the Achilles tendon.
- Certain rare medical conditions, such as Cushing’s syndrome, where the body makes too much of its own corticosteroid hormones. See the separate leaflet called Cushing’s Syndrome for more information.
- Tendinopathy of the Achilles tendon. See the separate leaflet called Achilles Tendinopathy for more information.
- Other medical conditions which can make the tendon more prone to rupture; for example, rheumatoid arthritis, gout and systemic lupus erythematosus.
- Certain antibiotic medicines may slightly increase the risk of having an Achilles tendon rupture. These are the quinolone antibiotics such as ciprofloxacin and ofloxacin. The risk of having an Achilles tendon rupture with these antibiotics is actually very low and mainly applies if you are also taking corticosteroid medication.
What Are Achilles Tendon Rupture Symptoms And Signs?
Background history
- Patients with an Achilles tendon rupture will often complain of a sudden snap in the back of the leg. The pain is often intense and patients will describe it as if being shot.
- With a complete rupture, the individual will only be able to ambulate with a limp. Most people will not be able to climb stairs, run, or stand on their toes.
- Swelling around the lower calf may occur.
- Patients may offer a history of recent sudden increase in exercise or intensity of activity.
- Some patients may have had recent corticosteroid injection or prescription or a course of fluoroquinolone antibiotics.
- Some athletes may have had a prior tendon inflammation or injury.
Physical exam
The health care provider will generally examine both legs.
A health care professionals examines the lower leg for swelling, bruising, and tenderness.
If there is a complete rupture of the Achilles tendon, a physician can palpate a gap or defect within the tendon.
Range of motion of the ankle will be lost and the patient will have difficult moving the ankle and foot.
The Thompson test helps confirm the diagnosis:
- The patient lies prone, face-down.
- The examiner squeezes the calf area.
- With an intact Achilles tendon, the foot will plantarflex and the toes point downward
- With Achilles tendon rupture, the foot does not move
The health care provider may also check for pulses and sensation in the foot.
Diagnosis Of Achilles Tendon Rupture
our doctor will ask you about your symptoms and how you think the injury happened. They may ask you to walk around or move your foot or leg, to see where you’re having difficulties. They’ll examine your leg, heel and ankle to check for any swelling and bruising. They may also ask you to lie down and squeeze your calf muscle to check the movement of your foot.
Usually, an examination on its own will tell your doctor if your Achilles tendon is ruptured. But if there’s any uncertainty about your diagnosis, your doctor may advise you to have an MRI or ultrasound scan.
If your GP thinks you may have ruptured your Achilles tendon, they’ll refer you to an orthopaedic surgeon for further assessment. This is a doctor specialising in conditions affecting your muscles, bones and joints.
- A physician usually can make this diagnosis with a good physical examination and history. X-rays usually are not taken.
- A simple test of squeezing the calf muscles while lying on your stomach should indicate if the tendon is still connected (the foot should point). This test isolates the connection between the calf muscle and tendon and eliminates other tendons that may still allow weak movement.
- A word of caution: Achilles tendon rupture is often misdiagnosed as a strain or minor tendon injury. Swelling and the continuing ability to weakly point your toes can confuse the diagnosis.
- Ultrasound and MRI are tests that can assist in difficult diagnosis. Depending on the degree of injury, these tests can also assist in determining which treatment may be best.
What Is the Treatment for an Achilles Tendon Rupture?
The objective of treatment is to restore normal length and tension to the tendon and allow you to do what you could do before the injury. Treatment reflects a balance between protection and early motion.
- Protection is necessary to allow time for healing and to prevent reinjury.
- Moving your foot and ankle is needed to prevent stiffness and loss of muscle tone.
- Treatment options are surgical or nonsurgical. The choice is controversial.
- Both surgical and nonsurgical treatment will require an initial period of about six weeks of casting or special braces. The cast may be changed at two- to four-week intervals to slowly stretch the tendon back to its normal length. Casting may be combined with early movement (one to three weeks) to improve overall strength and flexibility.
- A heel lift device and, regardless of the choice of treatment, regular physical therapy follow for the remainder of treatment.
- Consultation with an orthopedic surgeon will determine the treatment and follow-up that is right for you.
Achilles tendon rupture can be treated with either surgery or conservative (non-surgical) measures. Your doctor will assess your injury and discuss if surgery would be an option for you. Which treatment your doctor recommends will depend on several factors, including your age, your general health and how active you are.
You’ll usually need to wear a brace or cast on your leg to protect it from further injury while you wait for treatment. You may be asked not to put weight on the affected leg during this time. You may also be offered medicines to reduce your risk of developing deep vein thrombosis (DVT) while your leg is immobile.
Non-surgical treatment
Your doctor may be more likely to suggest conservative (non-surgical) treatment if you’re older, have other health problems or aren’t particularly active. This usually involves wearing casts or a brace to support your lower leg while the tendon heals. You may need to take over-the-counter painkillers while your tendon is healing.
Compared to surgery, non-surgical treatment has a smaller chance of complications. But there is a greater chance of having another rupture in the future.
Casting
Casts are usually from your knee downwards and are put on with your foot in a fully bent downwards position. You may have to wear a cast for several weeks, although they may be changed to gradually move your foot into a more neutral position. You won’t be able to put weight on your leg and will need crutches to move around.
Brace
A brace is a rigid type of boot with straps to adjust it. It usually fits from your knee downwards. Once the brace is on, it’s adjusted several times over a few weeks to lift your foot up. You can walk and put weight on your leg while wearing the brace, and you can also remove it to move your ankle joint.
Surgery
Your doctor may be more likely to suggest surgery if:
you’re young and active
you’re a competitive athlete
you’ve had a delay in treating the rupture
you keep rupturing your Achilles tendon
There are several different techniques for surgical repair of Achilles tendon. All involve bringing the torn ends of your tendon back together. You may have open surgery, which involves making a cut into your ankle to fix the tendon. Or you can have minimally invasive surgery, where your surgeon will reach the tendon through small holes.
Having surgery rather than non-surgical treatment means your tendon is less likely to rupture again. But with surgery there is a greater chance of complications, including infection of the wound and development of scar tissue. These risks may be lower with minimally invasive surgery. Your surgeon will explain the different options, so you can decide what’s best for you.
After your operation, you’ll need to wear a cast or an adjustable brace on your leg to help the tendon heal.
Rehabilitation
Whether you had surgery for your Achilles tendon or not, you’ll need a period of rehabilitation after your initial treatment. You should see a physiotherapist, who will guide you on exercises to increase the range of movement and strength in your ankle and lower leg. You’ll start with gentle exercises and build these up over time. You might have some exercises specifically designed to strengthen or stretch your calf muscles. Your physiotherapist may also advise you on what low-impact exercises, such as cycling, jogging or swimming, you can try.
How Long Does It Take To Recover From A Ruptured Achilles Tendon?
epending on the type of work, some people need several weeks off work after an Achilles tendon tear (rupture); the time taken to return to sport is between 4 and 12 months.
Generally, the outlook is good. However, the tendon does take time to heal, usually about six to eight weeks. More time will be needed after this to allow the muscles to regain their normal strength after being in a plaster cast or a brace (orthosis).
Possible complications are as follows:
- Whichever treatment option is used, there is a chance that the Achilles tendon will not heal fully and further treatment such as surgery may be needed.
- Complications of surgery: these are usually minor complications such as a wound infection or reduced sensation near the operation site. About 4 in 100 people develop a wound infection following surgery to fix a ruptured Achilles tendon.
- The tendon may scar or may become shorter during the healing process.
- There is also a chance that the tendon could become torn again later (re-rupture). According to some research, the risk of a re-rupture is about 4 in 100 with surgical treatment and about 12 in 100 with conservative treatment.
- A clot can form in the blood vessels in the leg and this is more common after an Achilles tendon rupture.
Can Achilles Tendon Rupture Be Treated At Home with Natural Remedies?
Initial treatment for sprains and strains should occur as soon as possible. Remember RICE!
Rest the injured part. Pain is the body’s signal to not move an injury.
Ice the injury. This will limit the swelling and help with the spasm.
Compress the injured area. This again, limits the swelling. Be careful not to apply a wrap so tightly that it might act as a tourniquet and cut off the blood supply.
Elevate the injured part. This lets gravity help reduce the swelling by allowing fluid and blood to drain downhill to the heart.
Over-the-counter pain medication is an option. Acetaminophen (Tylenol) is helpful for pain, but ibuprofen (Motrin, Advil, Nuprin) might be better, because these medications relieve both pain and inflammation. Remember to follow the guidelines on the bottle for appropriate amounts of medicine, especially for children and teens.
