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Achilles tendon rupture

A tendon is a tissue that connects a muscle to bone. An Achilles tendon rupture is when the Achilles tendon in your lower leg is torn, either partially or completely.

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). If you rupture your Achilles tendon, you can either partially or completely tear the tendon.

Illustration showing the Achilles tendon

An Achilles tendon injury occurs most often in athletes or people between the age of 30 and 50 who exercise intermittently, but it can affect anyone.

It happens most often in the left leg, since if you’re right-handed, you will ‘push off’ more frequently with the left foot when you run. A complete rupture is more common in men.

Symptoms of Achilles tendon rupture

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

  • have swelling in your lower leg (calf)
  • be unable to put your full weight on your ankle
  • be unable to stand on tiptoe, or climb stairs
  • develop bruising

If you have any of these symptoms and you think you have ruptured your Achilles tendon, go straight to an accident and emergency department at a hospital or to your GP surgery.

Causes of Achilles tendon rupture

You’re most likely to rupture your Achilles tendon during sports in which you have bursts of jumping, pivoting and running, such as football or tennis.

Your Achilles tendon becomes less flexible and less able to absorb the repeated stresses of running, for example, as you get older. Small tears can develop in the fibres of the tendon and the tendon 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 degrades, which causes pain and stiffness in your Achilles tendon both when you exercise and often after you exercise.

If you take certain medicines called quinolone antibiotics (eg ciprofloxacin) and corticosteroids, they can increase your risk of an Achilles tendon injury, particularly if you take these medicines together. The exact reasons why you may develop an Achilles tendon injury after taking these medicines aren't fully understood at present.

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.

Your doctor may refer you to hospital to have further tests, 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 radiowaves to produce images of the inside of your leg.

Treatment of Achilles tendon rupture

You can have an operation to treat an Achilles tendon rupture, or you can rest the tendon and keep it immobile in a plaster cast while it heals. 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. 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 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

A cast or brace will be put onto your lower leg to help the tendon heal. You will need to wear this for six to eight weeks. During this time, the cast will be changed a number of times to make sure your tendon heals in the right way.

This type of treatment is suitable for people who may have complications during surgery. However, there is a greater risk that your tendon will re-rupture, compared with surgery.

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

Surgery

Surgery is usually recommended for active young people.

There are three main types of surgery used 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 will 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 have 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 re-rupture after the operation.

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 (a health professional who specialises in maintaining and improving movement and mobility), 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 any pain you have. These may include exercises and soft tissue techniques (deep tissue massage). He or she will also advise you on how to return to exercise. You should be able to return to activity six months after your injury. However, this may take longer and will also depend on the activity.

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. Do five to 10 minutes of low intensity activity, such as brisk walking for both warm up and cool down. The benefit of stretching before or after exercise is unproven but you may find that it helps to also stretch your muscles by doing a calf muscle stretch, which will help to lengthen your Achilles tendon before you exercise.
  • Wear appropriate and well-fitting shoes when you exercise.
     

Produced by Rebecca Canvin, Bupa Health Information Team, June 2012.

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

For sources and links to further information, see Resources.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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  • Publication date: June 2010

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