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Achilles tendon rupture

Published by Bupa's health information team, May 2008.

This factsheet is for people who have an Achilles tendon rupture, or who would like information about it.

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.

Illustration showing the Achilles tendon
The Achilles 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.

Symptoms

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:

When the injury occurs, you may feel like you have been kicked or hit in the back of the leg.

Causes

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.

Diagnosis

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:

Treatment

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.

Surgery

There are two types of surgery that you may have:

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:

Between one and three in 100 people who have surgery are at risk of re-rupture.

Non-surgical treatment

Cast/brace

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.

Heel raise

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.

Rehabilitation

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:

Prevention

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.

Further information

Related topics

Sources

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: May 2008.