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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.

Your Achilles tendon is very strong and flexible. It’s at the back of your ankle and connects your calf muscle to the bone in the heel of your foot (calcaneum). If you rupture your Achilles tendon, you can either partially or completely tear the tendon. 

Most people who injure their Achilles tendon are between 30 and 50 and don’t exercise regularly. It’s more common in men but can affect anyone.

It happens most often in the left leg. This may be because most people are right-handed which means that they ‘push off’ more frequently with the left foot when running.

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Image showing the Achilles tendon

Details

  • Symptoms Symptoms of Achilles tendon rupture

    If you rupture your Achilles tendon, you may hear a snapping or popping sound when it happens. You will feel a sudden and sharp pain in your heel or calf (lower leg). It might feel like you have been kicked or hit in the back of your leg. You may also:

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

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

    If you partially rupture your Achilles tendon, the tear may only be small. Symptoms of pain and stiffness may come on quite suddenly like a complete rupture, but may settle over a few days.

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  • Diagnosis Diagnosis of Achilles tendon rupture

    Your doctor will ask you about your symptoms and examine you. He or she may also ask you about your medical history. Your doctor may ask you to do a series of movements or exercises to see how well you can move your lower leg. He or she may also examine your leg, heel and ankle and may squeeze your calf muscle to check the movement of your foot.

    You may need to have further tests to confirm if your tendon is torn, which may include the following.

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

    Your doctor may advise you to rest your leg and keep the tendon immobile in a plaster cast while it heals. Or you may need to have an operation to treat an Achilles tendon rupture. The treatment you have will depend on your individual circumstances, such as your age, general health and how active you are. It will also depend on whether you have partially or completely torn your tendon. If you have a partial tear, it might get better without any treatment. Ask your doctor for advice on the best treatment for you.

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

    Non-surgical treatment

    You may need to wear a plaster cast, brace or boot on your lower leg for six to eight weeks to help the tendon heal. During this time, your doctor will change the cast a number of times to make sure your tendon heals in the right way.

    If your tendon is partially ruptured, your doctor will probably advise you to have this treatment instead of surgery. It’s also suitable for people who aren't very physically active. However, there is a greater risk that your tendon will rupture again, compared with surgery. Your doctor will advise you which treatment is best for you.

    Surgery

    Your doctor may recommend surgery if you’re young and active, or an athlete. However, this 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.

    There are three main types of surgery to repair a ruptured Achilles tendon.

    • Open surgery. Your surgeon will make one long cut in your leg to reach the 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 the tendon and repair it.

    In all types of surgery, your surgeon will stitch the tendon together so it can heal. Each type of surgery has different risks. Open surgery is less likely to injure one of the nerves in your leg for example, but has a higher risk of infection. Ask your surgeon to explain the risks in more detail.

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

    There is a chance that your tendon will rupture again after the operation.

    After your treatment

    After you have your cast or brace removed, you will need to gradually increase your activity to strengthen your Achilles tendon. Your doctor, or a physiotherapist (a health professional who specialises in maintaining and improving movement and mobility), will give you exercises to do. These are designed to increase the range of movement and strength in your lower leg. You will start with gentle exercises and build these up over time.

    Your physiotherapist will also advise you on how to return to exercise. You should be able to return to activity six months to a year after your injury. However, this may take longer and will also depend on the activity.

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  • Causes Causes of Achilles tendon rupture

    There are a number of factors that can increase the risk of an Achilles tendon rupture, 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.
    • Your Achilles tendon becomes less flexible and less able to absorb repeated stresses, for example of running, as you get older. Small tears can develop in the fibres of the tendon and it may eventually completely tear.
    • There is a very small risk of an Achilles tendon rupture if you have Achilles tendinopathy (also called Achilles tendinitis). This is where your tendon breaks down, which causes pain and stiffness in your Achilles tendon, both when you exercise and afterwards.
    • If you take quinolone antibiotics and corticosteroid medicines, it can increase your risk of an Achilles tendon injury, particularly if you take them together. The exact reasons for this aren't fully understood at present.
  • Prevention Prevention of Achilles tendon rupture

    You can help to reduce your risk of an injury to 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. The benefit of stretching before or after exercise is unproven. However, it may help to stretch your calf muscles, which will help to lengthen your Achilles tendon, before you exercise.
    • Wear appropriate and well-fitting shoes when you exercise.
  • FAQs FAQs

    Will Achilles tendon rupture get better on its own, without treatment?

    Answer

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

    Explanation

    A ruptured Achilles tendon won't heal on its own without treatment and you may need to have surgery. Whether you have an operation or not, you will 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 four weeks.

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

    Will I be able to walk once my Achilles tendon rupture is treated?

    Answer

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

    Explanation

    Initially you won't be able to put weight, or walk, on your affected leg. However, you will be able to get around using crutches. This is usually for between four and eight weeks after your treatment.

    After this period, you should be able to gradually put weight on your affected leg – doctors call this weight-bearing. You may need to wear a shoe with a 2cm heel or shoe insert for a number of weeks after this. This will help to place your tendon in the best position to heal. Your doctor or physiotherapist will advise you when you can begin to put weight on your affected leg.

    Will I have to give up running or sport after an Achilles tendon rupture?

    Answer

    Most people fully recover and are able to return to running or other sports after an Achilles tendon rupture. It usually takes up to six months after your injury to return to sports. However, it may take longer and will also depend on the type of sport you do. It can take up to a year for athletes to get back to their full activities.

    Explanation

    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 amount of rehabilitation exercises you do
    • the level of activity you’re aiming to get back to

    Following treatment and rehabilitation, most people are able to return to the level of activity they had before their injury, including athletes. However, if you have a cast or brace rather than surgery, there is a greater chance that your tendon may rupture again. It’s possible that you may not be able to recover enough strength and flexibility in your tendon to go back to sport or running.

    The benefit of stretching before or after exercise is unproven. However, it may help 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. This can help to prevent your Achilles tendon from rupturing again.

  • Resources Resources

    Further information

    Sources

    • Achilles tendinitis. American Academy of Orthopaedic Surgeons. www.orthoinfo.aaos.org, published June 2010
    • Achilles tendonitis and rupture. PatientPlus. www.patient.co.uk/patientplus.asp, published 7 June 2013
    • Achilles tendon rupture. Medscape. www.emedicine.medscape.com, published 10 October 2012
    • Achilles tendon. British Orthopaedic Foot and Ankle Society. www.bofas.org.uk, accessed 27 February 2014
    • Achilles tendinopathy. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published April 2010
    • Achilles tendon injury. Sports Medicine Australia. www.sma.org.au, published 2010
    • Personal communication, Dr Tom Crisp, Clinical Director Bupa Musculoskeletal Services, 31 March 2014
    • 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
    • Thompson J, Baravarian B. Acute and chronic Achilles tendon ruptures in athletes. Clin Podiatr Med Surg 2011; 28(1):117–35. doi:10.1016/j.cpm.2010.10.002
    • 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
  • Related information Related information

  • Author information Author information

    Reviewed by Rachael Mayfield-Blake, Bupa Health Information Team, March 2014.

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