Achilles tendon rupture

An Achilles tendon rupture is a tear of the tendon that connects your calf muscles to your heel bone. It’s a common injury that usually happens while you’re playing sport or doing exercise. If you rupture your Achilles tendon, you’ll find it difficult to walk, run, climb stairs, or stand on tiptoe.

About Achilles tendon rupture

Tendons are strong and flexible tissues that connect muscles to other parts of your body, usually your bones. Your Achilles tendon is the largest and strongest tendon in your body. It helps you to lift your heel, which allows you to walk, run, and jump.

Your Achilles tendon is most likely to rupture (tear) if:

• your foot is suddenly forced upwards
• you push off the ground with force, such as when you jump

You can rupture your Achilles tendon at any age. But an Achilles tendon injury is most common in people aged 30 to 50 who occasionally play sport.

Causes of Achilles tendon rupture

Achilles tendon rupture is most likely to happen when you play sports that involve pushing off forcefully from your foot. These sports include:

• football
• gymnastics
• badminton
• basketball
• tennis

It can also be caused by an injury from a fall where your foot is suddenly forced into an upward-pointing position. This overstretches your tendon. Less commonly, an Achilles tendon injury can be caused by direct trauma, such as a deep cut over the tendon.

Some things can increase your risk of rupturing your Achilles tendon. These include:

• getting older
• having tendinopathy (damage to your tendon, usually from overuse)
• not warming up properly
• doing more exercise than you’re used to, or increasing the amount you do too quickly
• taking steroids and some antibiotics
• certain health conditions, including gout, rheumatoid arthritis and type 1 and type 2 diabetes

Symptoms of Achilles tendon rupture

If you rupture your tendon, you’re likely to have a sudden, sharp, and severe pain in the back of your leg. It might feel like you’ve been kicked or hit in the back of your leg. You might also hear a snap or pop sound when it happens. Usually, the pain then settles into a dull ache. But not everyone who ruptures their Achilles tendon feels pain.

Achilles tendon rupture symptoms may also include:

• some swelling in your calf
• difficulty walking - you might not be able to put your full weight on your leg or stand on tiptoe
• some bruising on your lower leg

If you have these symptoms, see a doctor urgently. It’s best to start Achilles tendon rupture treatment as soon as possible. Ideally, go to your nearest urgent treatment centre (minor injuries unit) or local Accident & Emergency (A&E) department.

Diagnosis of Achilles tendon rupture

Your doctor will ask you about your symptoms and how you think the Achilles tendon injury happened. They may also:

• ask you to walk around or move your foot or leg, to see how you move
• examine your leg, heel, and ankle to check for any swelling and bruising
• ask you to lie down and squeeze your calf muscle to check the movement of your foot

Usually, an examination on its own will tell your doctor if your Achilles tendon is ruptured. But if they aren’t sure, you’ll usually need to have an ultrasound scan. If an ultrasound shows there’s a gap in your Achilles tendon when you point your foot down, this means you have a tear. This will help your doctor decide whether or not you need surgery.

If your GP thinks you may have ruptured your Achilles tendon, they may refer you to an orthopaedic surgeon for further assessment. This is a doctor who specialises in conditions that affect your muscles, bones, and joints.

Treatment of Achilles tendon rupture

Achilles tendon rupture can be treated with either surgery or conservative (non-surgical) measures. Your doctor will let you know what treatment is best for you. This will depend on several things, including:

• your age
• your general health
• how active you are
• whether an ultrasound scan shows a gap between your torn tendon ends with your foot pointed down

You’ll usually need to wear a brace or cast on your leg to protect it from further injury while you wait for treatment. You might not be able to put weight on your leg during this time. Your doctor will talk to you about the risk of developing deep vein thrombosis (DVT) while your leg is immobile. They may offer you medicines to reduce your risk of developing DVT.

Non-surgical treatment

Your doctor may be more likely to suggest conservative (non-surgical) treatment if you:

• are older
• have other health problems
• aren’t particularly active

This usually involves wearing a brace or a walking boot to support your lower leg while the tendon heals. You may need to take over-the-counter painkillers while your tendon heals.

Compared to surgery, non-surgical treatment has a smaller chance of complications. But there’s a greater chance of having another rupture in the future.

Walking boots and braces

A brace is a rigid type of removable protective boot with straps to adjust it. It usually fits from your knee downwards. Once the brace is on, it’s adjusted several times over a few weeks to lift your foot up. You can walk and put weight on your leg while you wear the brace, and you can also remove it to move your ankle joint.

Surgery

Your doctor may be more likely to suggest surgery if:

• you’re young and active
• you’re a competitive athlete
• there’s been a delay in treating the rupture
• you keep rupturing your Achilles tendon
• an ultrasound scan shows a gap between your torn tendon ends with your foot pointed down

There are different types of surgery to repair an Achilles tendon injury but they all involve bringing the torn ends of your tendon back together. You may have:

• open surgery, which involves making a cut into your ankle to fix the tendon
• keyhole (minimally invasive) surgery, where your surgeon will make smaller cuts to reach the tendon

If you have surgery rather than non-surgical treatment, your tendon is less likely to rupture again. But surgery has a greater chance of complications, including infection of the wound and development of scar tissue. The chance of these risks may be lower with keyhole surgery. Your surgeon will explain the different options, so you can decide what’s best for you.

After your operation, you’ll need to wear a cast or an adjustable brace on your leg to help the tendon heal.

Rehabilitation

Whether you had surgery for your Achilles tendon or not, you’ll need a period of rehabilitation to heal after your initial treatment. You should see a physiotherapist, who will give you exercises to increase the range of movement and strength in your ankle and lower leg. You’ll start with gentle exercises and build these up over time. Your physiotherapist will give you advice on what low-impact exercise you can do during this time, such as cycling, jogging, or swimming.

Prevention of Achilles tendon rupture

There’s not always much you can do to prevent an Achilles tendon rupture. But you may be able to reduce your risk by making sure you stretch and warm up well before you exercise. It’s also important to build up the amount or intensity of your exercise gradually