Achilles tendon rupture
A tendon is a tissue that connects a muscle to bone. An Achilles tendon rupture is when the Achilles tendon is torn. This is the most frequently ruptured tendon in the body.
About Achilles tendon rupture
The Achilles tendon is very strong. It's found at the back of your ankle and connects your calf muscle to the bone in the heel of your foot. 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 over 45, but it can affect anyone. Complete rupture is more frequent in men.
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. You may:
- have swelling
- be unable to put your full weight on your ankle
- hear a snapping or tearing sound when it happens
When the injury occurs, you may feel like you have been kicked or hit in the back of the leg.
Achilles tendon rupture often happens when the leg is straight and your calf muscle is contracted during sports activities such as football, squash or basketball.
Achilles tendonitis, or degeneration of the tendon, may lead to the rupture of the Achilles tendon. Achilles tendonitis is when you feel pain and stiffness in the Achilles tendon after exercise. This pain may be worse during exercise too. You may also have tenderness and swelling, or a lump in the tendon. By increasing your exercise routine gradually, strengthening your calf muscles and wearing supportive footwear, you can help prevent Achilles tendonitis.
Certain medicines may increase the risk of Achilles tendon injuries. They include quinolone, antibiotics (eg ciprofloxacin) and corticosteroids. The exact risk of Achilles tendon rupture caused by these medicines isn't clear.
If you have a rupture, you may go directly to the accident and emergency department of a hospital or you may visit your GP. The doctor who examines you will ask about your symptoms. He or she may also ask you about the activity you were doing when the injury happened. You will then be referred to a specialist for treatment.
Your GP or a doctor at the hospital may do the Simmonds calf squeeze test. This is when the fleshy part of the calf is squeezed to see if your foot flexes, causing the toes to point downwards. If the foot doesn't flex the Achilles tendon is damaged. You may need to lie on your front for this test to be performed. You may also be asked to stand on your tiptoes.
At the hospital, the specialist may do some further tests to look at the damaged Achilles tendon. These can include:
- an ultrasound scan, which uses high frequency sound waves to produce an image of the Achilles tendon to look for any damage
- an MRI (magnetic resonance imaging) scan, which uses magnets and radiowaves to produce two- and three-dimensional pictures of the leg that can help your doctor see if there is damage to the Achilles tendon
Achilles tendon ruptures are treated using surgery and/or immobilisation. If the tendon is partially ruptured, non-surgical treatment may be advised. You can take the painkiller you usually take for a headache for any pain.
There are two types of surgery that you may have:
- open surgery - which is when a cut is made to reach the tendon to repair it
- percutaneous surgery - which is when smaller cuts are made to reach the tendon to repair it
Both types of surgery will involve stitching the tendon together so it can heal. Surgery is usually recommended for active young people who will have limited complications both during and after surgery.
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 at least six to eight weeks.
Complications of surgery
About five in 100 people who have surgery for this injury get an infection. Antibiotics will be given for any infections which develop. There may be a lower risk of infection if you have percutaneous surgery. More severe infections can lead to the wound breaking down, which requires plastic surgery. This is serious but is rare.
Other complications of surgery can include:
- deep vein thrombosis (DVT) - blood clot in the leg
- pulmonary embolism - blood clot in the lung
- a reaction to the anaesthetic
Between one and three in 100 people who have surgery are at risk of re-rupture.
A cast or brace is used to help keep the tendon aligned so it can heal. This will be for at least six to eight weeks. It usually takes longer to recover from Achilles tendon rupture using this form of 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.
Re-rupture may occur in between 13 and 20 in every 100 people who have this treatment. The rate of re-rupture is higher with non-operative treatment, but the risks of surgery are eliminated. You can decide with your surgeon your risks and decide on the appropriate treatment for you.
This can help the Achilles tendon because it's shorter when it's raised so it can knit together and heal. A heel raise may be used with a brace or cast.
For both surgical and non-surgical treatments you will need to stretch and strengthen your calf muscles to help the injury heal while wearing the cast or brace.
Once the cast or brace is removed you will need to gradually increase your activity to strengthen the tendon.
Always seek advice from a Chartered Physiotherapist who can assess and treat you according to your individual needs. It's most likely that they would offer:
- soft tissue techniques to soften the scar tissue which may include ultrasound therapy
- specific and safe methods to stretch your Achilles tendon and calf muscle
- appropriate strengthening exercises depending on the method of treatment and when you got the injury
- mobilise and loosen any stiff joints, this occurs more frequently following a cast/brace
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 of your exercise and the length of time you spend exercising.
Warming up your muscles before you exercise and cooling them down after you have finished may be beneficial. 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 stretches for the muscles 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.
Chartered Society of Physiotherapy
British Orthopaedic Foot and Ankle Society
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