Achilles tendon rupture

Published by Bupa's Health Information Team, June 2010.

This factsheet is for people who have an Achilles tendon rupture, or who would like information about it.

A tendon is a tissue that connects a muscle to bone. An Achilles tendon rupture is when the Achilles tendon in the lower leg is torn, either partially or completely. It's the most frequently ruptured tendon in the body.

About Achilles tendon rupture

The Achilles tendon is very strong and flexible. It's found at the back of your ankle and connects your calf muscle to the bone in the heel of your foot (calcaneum). When an Achilles tendon rupture happens you may partially or completely tear the tendon.

This type of injury occurs most often in athletes or people between the age of 30 and 50, but it can affect anyone. Complete rupture is more common in men.

Symptoms of Achilles tendon rupture

If you rupture your Achilles tendon you will feel a sharp pain in the back of your leg and you will be unable to flex your ankle or point your toes. You may:

• have swelling in your lower leg
• be unable to put your full weight on your ankle
• hear a snapping or tearing sound when it happens
• have a limp, and be unable to stand on tiptoe or climb stairs
• develop bruising

When the injury occurs, you may feel like you have been kicked or hit in the back of the leg.

Causes of Achilles tendon rupture

Achilles tendon rupture is most likely to happen when your leg is straight and your calf muscle is contracted during activities such as running, jumping or playing sport such as football or tennis.

There is a very small risk of Achilles tendon rupture if you have Achilles tendinopathy. Achilles tendinopathy is pain, thickening and stiffness in your Achilles tendon both during exercise and often following exercise.

Certain medicines taken together may increase the risk of Achilles tendon injuries. These are quinolone antibiotics (eg ciprofloxacin) and corticosteroids. The exact risk of Achilles tendon rupture caused by these medicines isn't clear.

Diagnosis of Achilles tendon rupture

If you have a rupture, you must go straight to an accident and emergency department or to your GP. The doctor you see will ask about your symptoms and examine you. You will be referred to a specialist for treatment. Your doctor may ask you to do a series of movements or exercises to see how well you can move and how affected your lower leg is. These may include squeezing your calf muscle or asking you to try to stand on tiptoe.

At the hospital, you may have further tests to look at your Achilles tendon. These may include:

• an ultrasound scan, which uses sound waves to produce an image of the inside of a part of the body
• an MRI (magnetic resonance imaging) scan, uses magnets and radiowaves to produce images of the inside of the body

Treatment of Achilles tendon rupture

Achilles tendon ruptures are treated using surgery, or by keeping it immobile while it heals. The treatment you have may depend on how much time has passed since the injury, your age and how active you are.

Whether you have an operation or not, you will have a plaster cast on your lower leg and won't be able to put weight on it for at least four weeks.

You can take painkillers that you would usually take for a headache, for example a non-steroidal anti-inflammatory painkiller such as ibuprofen. Always read the patient information leaflet that comes with your medicine.

Surgery

Surgery is usually recommended for active young people.

There are two types of surgery used to repair a ruptured Achilles tendon:

• open surgery, which is when one long cut is made to reach the tendon to repair it
• percutaneous surgery, which is when a number of small cuts are made to reach the tendon to repair it

Both types of surgery involve stitching the tendon together so it can heal. Open surgery is less likely to cause injury to one of the nerves in your leg.

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

About five in 100 people who have surgery for this injury get an infection. This can be treated with antibiotics. There may be a lower risk of infection if you have percutaneous surgery. For between one and three in 100 people the tendon will re-rupture after the operation.

Non-surgical treatment

A cast or brace is put onto your lower leg to help the tendon heal. You will have to wear a cast or brace for at least six to eight weeks. During this time the cast will be changed a number of times to make sure the tendon heals in the right way. It usually takes longer to recover from Achilles tendon rupture using this treatment, compared with surgery.

There is no risk of infection from this type of treatment and it's suitable for people who may have complications during surgery.

The tendon may re-rupture in about 13 in every 100 people who have this treatment.

If your tendon is partially ruptured you're more likely to be given a cast or brace, instead of surgery.

After your treatment

Once your cast or brace is removed you will need to gradually increase your activity to strengthen the tendon. Your doctor, or a physiotherapist, will give you a number of exercises to do, which will increase the range of movement and strength in your lower leg. Your physiotherapist may try various techniques to reduce the pain. These may include exercises and soft tissue techniques (deep tissue massage). He or she will also advise you on returning to exercise. You should be able to return to your usual level of activity six months after your injury. However, this may take longer and will also depend on the activity.

Prevention of Achilles tendon rupture

There are ways to reduce the risk of injury to your Achilles tendon. To prevent injury when starting a new exercise regime, gradually increase the intensity and the length of time you spend being active.

Warming up your muscles before you exercise and cooling them down after you have finished may help. Five to 10 minutes of low intensity activity, such as brisk walking, is enough for a warm up and this is also needed for a cool down. You can do a series of muscle stretches to help prevent injuries after your warm up and cool down. This can include a calf muscle stretch, which will lengthen the Achilles tendon before you exercise.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.