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Achilles tendon rupture

An Achilles tendon rupture is when you tear the tissue that connects your calf muscle to your heel bone. If you rupture your Achilles tendon, you can either partially or completely tear the tendon. This makes it difficult to walk and your ankle will feel weak. Although you can rupture your Achilles tendon at any age, most people are between 27 and 49 when they do it, and don’t exercise much.

Image showing the Achilles tendon

Details

  • About About the Achilles tendon

    Your Achilles tendon is really strong and flexible. It’s at the back of your ankle and connects your calf muscle to a bone in the heel of your foot called the calcaneum. When your Achilles tendon pulls on your heel, it makes you go up on tiptoe, or pushes you forwards when you walk or run.

  • Symptoms Symptoms of Achilles tendon rupture

    If you rupture your Achilles tendon, you might hear a snapping or popping sound when it happens. You’ll feel a sudden and sharp pain in your heel or calf (lower leg) too. It might feel like you’ve been kicked or hit in the back of your leg. The pain will then settle into a dull ache or it may go completely. You may also:

    • have some swelling in your calf
    • be unable to put your full weight on your ankle, or stand on tiptoes, or climb stairs
    • have some bruising around the area

    If you have any of these symptoms and think you’ve ruptured your Achilles tendon, go straight to accident and emergency at your local hospital.

    If you partially rupture your Achilles tendon, you may get some pain and stiffness that may come on quite suddenly. But you won’t hear the snapping sound and you will probably still be able to put your weight on your ankle and walk.

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  • Diagnosis Diagnosis of Achilles tendon rupture

    Your doctor will ask you about your symptoms and your medical history. They’ll examine your leg, heel and ankle and may squeeze your calf muscle to check the movement of your foot. Your doctor may ask you to do some movements or exercises to see how well you can move your lower leg too.

    You may need to have some tests to confirm if your tendon is torn, such as:

    • an ultrasound scan, which uses sound waves to produce an image of the inside of your leg
    • an MRI scan, which uses magnets and radio waves to produce images of the inside of your leg
  • Treatment Treatment of Achilles tendon rupture

    The treatment you’ll need will depend on whether you’ve partially or completely torn your tendon. It will also depend on things like your age, general health and how active you are.

    Non-surgical treatment

    You might be able to wear a plaster cast, brace or boot on your lower leg for six to eight weeks. This will keep your tendon immobile while it heals. During this time, your doctor will change the cast a number of times to make sure your tendon heals in the right way. You’ll need to use crutches to keep the weight off your leg.

    If you need pain relief while your tendon heals, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist for advice.

    This treatment might be a good option for you if you aren't very physically active. But there’s more risk that your tendon may rupture again, compared with surgical treatment. Ask your doctor which treatment is best for you.

    Surgery

    Your doctor may recommend surgery if you’re young and active, or an athlete, but it will depend on where your tendon is ruptured. If the rupture is at, or above, the point at which your tendon merges with your calf muscle, for example, surgery may not be possible. Ask your doctor if it’s an option for you.

    There are three main ways your surgeon can do the operation to repair a ruptured Achilles tendon.

    • Open surgery. Your surgeon will make one long cut in your leg to reach your tendon and repair it.
    • Limited open surgery. Your surgeon will still make a single cut but it will be shorter.
    • Percutaneous surgery. Your surgeon will make a number of small cuts to reach your tendon and repair it.

    In all these operations, your surgeon will stitch your tendon together so it can heal. Each type of surgery has different risks. There’s a chance that your tendon will rupture again after the operation. And whereas open surgery is less likely to injure one of the nerves in your leg for example, it has a higher risk of infection. Ask your surgeon to explain the risks in more detail.

    After your operation, you’ll need to wear a series of casts or an adjustable brace on your leg to help your Achilles tendon heal. This is usually for between four and six weeks.

  • Aftercare After your treatment

    After you have your cast or brace removed, you’ll need to gradually increase your activity to strengthen your Achilles tendon. You might need to do some physiotherapy. Your doctor, or a physiotherapist, will give you exercises to do to increase the range of movement and strength in your lower leg. You’ll start with gentle exercises and build these up over time.

    You might need to wear inserts in your shoe – see ‘Will I be able to walk again?’ for more information about recovering.

    Your physiotherapist will give you some advice on how to get back to doing some exercise. You should be able to return to exercising normally four months to a year after your injury. But this depends on what type of activity you want to do and how fit you are – it may take longer. And some athletes find they can never return to the same level of activity as before.

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  • Causes Causes of Achilles tendon rupture

    There are a number of things that can increase your risk of rupturing your Achilles tendon, which include the following.

    • You’re most likely to rupture your Achilles tendon during sports that involve bursts of jumping, pivoting and running, such as football or tennis. You can also rupture your Achilles tendon if you have a fall and over-stretch your foot.
    • Your Achilles tendon becomes less flexible and less able to absorb repeated stresses, such as running, as you get older. Small tears can develop in the fibres of the tendon and it may eventually completely tear.
    • If your foot rolls inwards when it hits the ground – which is called overpronation – you might be more likely to rupture your Achilles tendon.
    • There’s a very small risk of an Achilles tendon rupture if you have Achilles tendinitis – also known as Achilles tendinopathy. This is where your tendon breaks down – for more information see Related information below.
    • If you take quinolone antibiotics and corticosteroid medicines, it can increase your risk of an Achilles tendon injury, particularly if you take them together. This is because these medicines are harmful to the cells in your tendon and stop its ability to repair itself.
  • Prevention Prevention of Achilles tendon rupture

    You can help to reduce your risk of injuring your Achilles tendon by doing the following.

    • When you start a new exercise regime, gradually increase the intensity and the length of time you spend being active.
    • Warm up your muscles before you exercise and cool them down after you have finished. There’s no proof that stretching before or after exercise helps but it’s worth trying. It may help to stretch your calf muscles, which will help to lengthen your Achilles tendon, before you exercise.
    • Wear suitable and well-fitting shoes when you exercise.
  • FAQ: Will I be able to walk again? Will I be able to walk after treatment?

    You’ll need to rest for four to six weeks to allow your tendon to heal. After this you can gradually start to walk again.

    More information

    To begin with, you won't be able to put weight, or walk, on your affected leg. You’ll need crutches to get around. This is usually for between four and six weeks after your treatment.

    After this time, you should be able to gradually put weight on your affected leg and do what’s called weight-bearing activities. You might need to wear a shoe with a one to two inch heel or shoe insert for some weeks after this. Remember to put an insert in both shoes so you’re balanced. This will help to put your tendon in the best position to heal. Your doctor or physiotherapist will let you know when you can begin to put weight on your leg.

  • FAQ: Will it get better without treatment? Does an Achilles tendon rupture get better?

    No, if you’ve completely torn your Achilles tendon, it won't get better on its own. You’ll need to have medical treatment.

    More information

    If you’ve ruptured your Achilles tendon, you may need to have an operation to treat it. And whether you have surgery or not, you’ll still need to have a plaster cast on your lower leg. You won't be able to put weight on your leg for at least six weeks.

    If your tendon ruptures, the sooner you seek treatment, the more treatment choices you’ll have and the better your chances of a full recovery. Ask your doctor for advice on the best type of treatment for you.

  • FAQ: Will I still be able to do sport? Will I have to give up sport after a rupture?

    Most people fully recover and can return to running or other sports after an Achilles tendon rupture. It usually takes about four months after your injury to get back into it. But it can take longer – it can take up to a year for athletes to get back to their full activities.

    More information

    How well you recover after the rupture of your Achilles tendon may depend on:

    • the kind of treatment you have
    • your rehabilitation after treatment
    • the number of rehabilitation exercises you do
    • the level of activity you’re aiming to get back to

    Most people can get back to the level of activity they had before their injury, including athletes. But if you have a cast or brace rather than surgery, there’s a greater risk that your tendon will rupture again. It’s also possible that you may not be able to recover enough strength and flexibility in your tendon to go back to your usual sports.

    There isn’t any scientific proof to show that stretching before or after exercise works. But you might find it helps to stretch and warm up and cool down well before and after you exercise. It’s important to wear well-fitting shoes that are right for the activity you’re doing too. This can help to prevent your Achilles tendon from rupturing again.

  • Other helpful websites Other helpful websites

    Further information

    Sources

    • Achilles tendinopathy. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised April 2010
    • Achilles tendonitis and rupture. PatientPlus. www.patient.info/patientplus, last checked 7 June 2013
    • Achilles tendon. British Orthopaedic Foot and Ankle Society. www.bofas.org.uk, accessed 22 February 2016
    • Kannus P, Józsa L. Histopathological changes preceding spontaneous rupture of a tendon. A controlled study of 891 patients. J Bone Joint Surg Am 1991; 73(10):1507–25. http://jbjs.org
    • Musculoskeletal problems. Oxford handbook of general practice (online). Oxford Medicine Online. oxfordmedicine.com, published March 2014
    • Achilles tendon injuries. Medscape. emedicine.medscape.com, updated 3 June 2014
    • Achilles tendon injuries. Sports Medicine Australia. sma.org.au, accessed 22 February 2016
    • Personal communication, Dr Leon Creaney, Consultant in Sport and Exercise Medicine, Bupa, 4 April 2016
    • The diagnosis and treatment of acute Achilles tendon rupture. American Academy of Orthopaedic Surgeons. www.aaos.org, published 4 December 2009
    • Khan RJK, Carey Smith RL. Surgical interventions for treating acute Achilles tendon ruptures. Cochrane Database of Systematic Reviews 2010, Issue 9. doi: 10.1002/14651858.CD003674.pub4
    • Ferri FF. Ferri's clinical advisor 2016 ed. Philadelphia: Elsevier, 2016
    • Sharma P, Maffulli N. Tendon injury and tendinopathy: healing and repair. J Bone Joint Surg Am 2005; 87:187–202. doi:10.2106/JBJS.D.0185
    • Dean BJ, Lostis E, Oakley T, et al. The risks and benefits of glucocorticoid treatment for tendinopathy: a systematic review of the effects of local glucocorticoid on tendon. Semin Arthritis Rheum 2014; 43(4):570–6. doi: 10.1016/j.semarthrit.2013.08.006
    • Herbert RD, de Noronha M, Kamper SJ. Stretching to prevent or reduce muscle soreness after exercise. Cochrane Database of Systematic Reviews 2011, Issue 7. doi: 10.1002/14651858.CD004577.pub3
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    Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, May 2016.
    Peer reviewed by Dr Leon Creaney, Consultant Sport and Exercise Medicine Physician.
    Next review due June 2018.

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