The Achilles tendon joins the calf muscles to the heel bone; with a complete tear you cannot rise onto the toes of that foot [1]. Treatment is either non-surgical (a cast or boot for at least 6 weeks) or surgical, chosen according to age, activity level and occupation [1]. Full recovery can take 12 to 24 months [1].
What is an Achilles rupture?
The Achilles tendon connects the calf muscles to the heel bone and lets you push the foot downwards. A tear can be partial (some fibres are torn but the tendon stays in one piece) or complete (the tendon separates from the heel bone or in its middle) [1].
What causes it?
Sudden stretching of the calf, for example on landing from a jump or changing direction, or a direct blow to the heel. Other factors weaken the tendon: corticosteroid injections for Achilles tendinitis, chronic inflammatory diseases such as rheumatoid arthritis and lupus, diabetes, obesity, certain antibiotics (ciprofloxacin, levofloxacin), and corticosteroid or anabolic steroid use [1].
The middle part of the tendon, roughly 6 cm above the heel, has a poorer blood supply than the rest [1].
How do you recognise it?
- A pop at the moment of injury
- Severe pain and swelling near the heel
- Difficulty walking on the injured leg
- Not being able to rise onto the toes of that foot
Diagnosis
On examination we check whether you can rise onto your toes, the flexibility of the ankle, and perform the Thompson test (squeezing the calf to see whether the foot moves) [1]. An X-ray detects bone fragments pulled off the heel, ultrasound shows how the tendon moves, and MRI shows where the tear is and how extensive it is [1].
Non-surgical treatment
The foot is held pointing downwards in a cast, boot or splint for at least 6 weeks, with crutches or a wheelchair at first. Once the tendon has healed, physiotherapy restores movement and strength [1].
When is surgery recommended?
The type of tear, your activity level, age and occupation guide the choice, and the question of surgery versus non-surgical care remains debated [1]. Surgery is advised for competitive athletes and for people whose work needs jumping and pushing off with the toes; it may give better push-off strength and a lower re-rupture rate, though research is ongoing [1].
A tear at the heel is anchored back to the bone with a device; a tear in the middle is repaired with sutures, and minimally invasive surgery is possible. If much time has passed, donated tissue can bridge the gap [1]. Repair soon after injury gives better results, because the tendon shortens and scars with time [1].
Recovery
A boot or splint is worn for about six weeks; after that the boot is gradually reduced and movement and strengthening exercises begin. Full recovery usually takes 12 to 24 months and in some patients close to two years [1].
Whichever treatment is chosen some loss of strength can remain, but most people return to their previous level of activity. Return to sport is decided with a set of tests [1].
What can go wrong?
Surgical problems include infection, nerve injury, wound breakdown, anaesthetic and clot complications, and continuing pain or weakness on pushing off or jumping; the tendon can also tear again after repair [1].
Frequently asked questions
- Can you walk with a ruptured Achilles?
- Walking is difficult; with a complete tear you cannot rise onto the toes of the injured foot [1].
- Does an Achilles rupture heal by itself?
- With non-surgical treatment the tendon can heal when held still for at least 6 weeks; the choice depends on the type of tear and your activity [1].
- Is surgery essential?
- No. Surgery is advised especially for athletes and for jobs that need pushing off with the toes; the choice is individual [1].
- How long does recovery take?
- Usually 12 to 24 months, with at least 6 weeks in a boot or cast [1].
- Will I be able to return to sport?
- Most people return to their previous level of activity, although some loss of strength can remain [1].
At our clinic we make the choice with you, from the type of tear and what your foot has to do in your life.
Sources
- Achilles Tendon Rupture (Tear). American Academy of Orthopaedic Surgeons (OrthoInfo), n.d.. orthoinfo.org
This article is general information and does not replace an examination or imaging. If you have symptoms, see a doctor.
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