Achilles tendon rupture

What is it?

The Achilles tendon connects the muscles in the back of your calf to your heel bone and is the largest tendon in the human body. Overstretching this thick fibrous tendon can result in a partial or complete tear (rupture). It is more common in very active people and sportsmen and women, but can happen to anyone. Patients often report hearing a pop when rupturing their Achilles tendon, which is followed quickly by a sharp pain in the back of the ankle and lower leg, that can make walking almost impossible.

Why does it occur?

The Achilles tendon can tear if it is subjected to a very high force or stress, and occurs most frequently in those who engage in sports or activities that involve repetitive leg lunging-type movement, such as football, tennis, badminton and squash. The strong contraction in the calf muscles during the push-off movement can put too much stress on the Achilles tendon. It can also tear or rupture during a fall or slip, if the foot is forced into an abnormal upward pointing position. Certain medical conditions can cause the Achilles tendon to weaken, making it more susceptible to damage. If a patient has had long term Achilles tendonitis, they are also more at risk of a rupture. 

What are the symptoms?

Achilles tendon ruptures often occur unexpectedly, and patients frequently report feeling a sudden pain in the heel or calf, which settles to a dull ache or disappears. Patients often report a popping sound and describe the feeling as if someone has hit them in the back of the leg. Some swelling and bruising in your calf may occur and it is usually difficult to walk. 

How is it diagnosed?

Your consultant will take a medical history and examine your foot and leg, looking for a gap of about 5cm above the heel bone, which is commonly felt in the tendon if you have what is called an intra-substance tear. If the rupture has occurred further up, around 10cm above the heel, this is known as a musculotendinous tear. A calf squeeze test may be performed to determine the exact sort of injury you have incurred, and to confirm a diagnosis and determine the precise site of the rupture, ultrasound scans may also be necessary.

How is it treated?

Non-surgical treatment

Brace treatment involves being in a lower-leg cast for at least two weeks, and then wearing a specialised boot that holds your leg in a set position, allowing the tendon to heal while you remain mobile. Over time your boot will be adjusted, allowing the foot to resume a more neutral position, and physiotherapy once your boot is removed may be required for several weeks until the medical team is satisfied the tendon is fully healed.

Surgical treatment

Should you require surgery, the necessary procedure takes about an hour, and involves making an incision over the Achilles tendon and repairing the tendon with stitches. You will be fitted with a cast after surgery, and at your follow-up appointment approximately two weeks later, you will wear a brace, as above. 

Treatment options

Achilles tendon reconstruction

Brace and boot treatment

The One Orthopaedics team specialists

Julie Kohls

Consultant Orthopaedic Foot and Ankle Surgeon FRCS (Tr & Orth)