What is an Achilles tendon rupture?
An Achilles tendon rupture is a tear of the tendon (a strong band of tissue) that connects your calf muscle to your foot’s heel bone. The tear may be complete or partial.
It usually happens when you place a lot of force on your foot or ankle. It can also just happen on its own.
Anyone can rupture their Achilles tendon, but it is more common if you are active, male, and aged between 30 to 50. It is also commonly seen in women aged over 60.
Symptoms include a sudden, sharp pain in the back of your lower leg or ankle, and you may have difficulty walking. If you think you have torn your Achilles tendon, or you aren’t sure, see your doctor immediately or go to the nearest hospital. Getting treatment early can help you to make a good recovery.
How do I know if I've ruptured my Achilles tendon?
An Achilles tendon rupture often happens while playing sports.
You may feel a sudden sharp pain in the ankle. You might also hear a ‘snap’ or feel like you have been kicked in the back of the leg when your Achilles tendon ruptures.
The pain usually turns into a dull ache in the back of your lower leg. Some people feel calf or heel pain for a few days leading up to the rupture.
Other symptoms of an Achilles tendon rupture may include:
- difficulty walking normally or standing on tiptoe
- swelling in and around your calf
- bruising around your lower leg
What are the causes of an Achilles tendon rupture?
The exact reason why some people may rupture their Achilles tendon is not fully understood. However, it tends to occur when you place a lot of stress on the tendon.
Common triggers for an Achilles tendon rupture include:
- falling from height
- stumbling or falling into a hole
- running, jumping or other sports in which you have to push off with your foot, such as sprint starts
- a deep cut in the back of the ankle over the site of the Achilles tendon
Sometimes, your Achilles tendon can rupture on its own.
Factors that increase your risk include:
- getting older – natural wear and tear weakens the Achilles tendon over time
- having long-standing or recurrent Achilles or a previous Achilles tendon injury
- steroid medicines
- certain types of antibiotics, called quinolones
- previously having steroid injections near the Achilles tendon
- certain medical conditions, such as , and
- inappropriate footwear
How is an Achilles tendon rupture diagnosed?
Your doctor may be able to diagnose an Achilles tendon rupture based on your symptoms, medical history and an examination of your foot and leg.
To help confirm the diagnosis or if the diagnosis is unclear, your doctor may organise the following tests:
- an MRI scan
- an ultrasound
If your doctor suspects you have broken a bone, you may also need an X-ray of your ankle or foot.
How is an Achilles tendon rupture treated?
If you think you have ruptured your Achilles tendon, arrange to see your doctor or get help to make your way to an emergency department as soon as possible. In the meantime, avoid putting weight on the injured leg.
There are two types of treatment for Achilles tendon rupture, surgical or non-surgical treatment (conservative treatment). However, it is currently not known if one type of treatment is better than the other.
The exact treatment you receive often depends on your individual circumstances and preferences.
Regardless of the treatment you have, you will most likely need to wear a plaster cast or leg brace while your injury heals. You will also need physiotherapy to strengthen the tendon and get back to your normal activities.
Conservative (Non-surgical treatment)
If you are over 65, less active or have certain medical conditions, such as diabetes, your doctor may recommend allowing your Achilles tendon to heal naturally without surgery. This is known as conservative treatment.
Conservative treatment may also involve:
- resting the injured foot by avoiding weight bearing initially
- non-prescription painkillers
- wearing a plaster cast or walking boot two weeks onwards
- weight bearing as tolerated on advice from your doctor
If the tendon does not heal on its own, you may need to have surgery.
Achilles tendon rupture surgery
In some cases, your doctor may recommend surgery to treat a ruptured Achilles tendon.
Your doctor may recommend surgery if:
- you are a competitive athlete
- you are very active
- there was a delay in diagnosing or treating the rupture
- you have ruptured your Achilles tendon before
Several types of surgery can be used to treat an Achilles tendon rupture, including open surgery (performed through a large open cut) and percutaneous surgery (performed through a tiny cut in your ankle).
The main benefit of having surgery instead of conservative treatment is that it reduces your risk of another rupture. However, it carries a risk of nerve damage and infection of the surgical wound. Because percutaneous surgery uses small cuts, this type of surgery can reduce your risk of getting a wound infection.
After your operation, you will usually need to wear a cast or leg brace for several weeks while the tendon heals. You should avoid weight bearing until your surgeon tells you it is safe to do so.
Your surgeon may also refer you to a physiotherapist to help you strengthen your Achilles tendon as you recover and return to normal activities.
Achilles tendon rupture recovery
It can take around 8–12 weeks for an Achilles tendon rupture to heal and 4–12 months to return to sports and exercise. However, your exact recovery time may vary depending on how severe your injury is.
Some competitive athletes may notice they are unable to return to the same level of activity as before the injury.
There is also a chance that your Achilles tendon may not heal fully after surgical or conservative treatment. If this happens, your surgeon may recommend further treatment, including surgery.
An Achilles tendon rupture carries a risk of several complications, which include:
- another rupture of the tendon
- calf muscles that tire more easily
- a scarred and shortened Achilles tendon
You will likely need to take time off work to allow your tendon to heal. The amount of time off you may need will depend on your job. Speak to your doctor for advice.
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