What is an Achilles tendon rupture?

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

Your Achilles tendon is most likely to rupture (tear) if your foot is suddenly forced up or you push off the ground with force, as in jumping.

Although you can rupture your Achilles tendon at any age, it’s most common in people aged 30 to 50 who occasionally take part in sport. It’s also more common in men than women.

Causes of Achilles tendon rupture

Achilles tendon rupture is most likely to happen while playing sports where you need to push off forcefully from your foot. Examples include football, running, basketball, diving and tennis.

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

There are certain things that can put you at greater 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 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 snapping or popping sound when it happens. Usually, the pain then settles into a dull ache. You may also have:

some swelling in your calf
difficulty walking and inability to put your full weight on the affected leg or to stand on tiptoe
some bruising on your lower leg

If you have these symptoms, see a doctor urgently. It’s best to start treatment for a ruptured Achilles tendon as soon as possible. If you can’t see your GP, go to your nearest urgent treatment centre (minor injuries unit).

Diagnosis of Achilles tendon rupture

Your doctor will ask you about your symptoms and how you think the injury happened. They may ask you to walk around or move your foot or leg, to see where you’re having difficulties. They’ll examine your leg, heel and ankle to check for any swelling and bruising. They may also 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 there’s any uncertainty about your diagnosis, your doctor may advise you to have an MRI or ultrasound scan.

If your GP thinks you may have ruptured your Achilles tendon, they’ll refer you to an orthopaedic surgeon for further assessment. This is a doctor specialising in conditions affecting 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 assess your injury and discuss if surgery would be an option for you. Which treatment your doctor recommends will depend on several factors, including your age, your general health and how active you are.

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 may be asked not to put weight on the affected leg during this time. You may also be offered medicines to reduce your risk of developing deep vein thrombosis (DVT) while your leg is immobile.

Non-surgical treatment

Your doctor may be more likely to suggest conservative (non-surgical) treatment if you’re older, have other health problems or aren’t particularly active. This usually involves wearing casts or a brace to support your lower leg while the tendon heals. You may need to take over-the-counter painkillers while your tendon is healing.

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

Casting

Casts are usually from your knee downwards and are put on with your foot in a fully bent downwards position. You may have to wear a cast for several weeks, although they may be changed to gradually move your foot into a more neutral position. You won’t be able to put weight on your leg and will need crutches to move around.

Brace

A brace is a rigid type of 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 wearing 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
you’ve had a delay in treating the rupture
you keep rupturing your Achilles tendon

There are several different techniques for surgical repair of Achilles tendon. 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. Or you can have minimally invasive surgery, where your surgeon will reach the tendon through small holes.

Having surgery rather than non-surgical treatment means your tendon is less likely to rupture again. But with surgery there is a greater chance of complications, including infection of the wound and development of scar tissue. These risks may be lower with minimally invasive 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 after your initial treatment. You should see a physiotherapist, who will guide you on 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. You might have some exercises specifically designed to strengthen or stretch your calf muscles. Your physiotherapist may also advise you on what low-impact exercises, such as cycling, jogging or swimming, you can try.

Recovery from Achilles tendon rupture

How long it takes to recover from an Achilles tendon rupture is similar whether you have surgery or not. You can expect to be back to normal activities, including low-impact sports, within four to six months, whichever treatment you have. But it can take longer to get back to high-impact sports, such as football, squash or tennis.

Most people can return to the type of activity that they did before their injury. But if you play sport at a professional level, you may find some limitations in what you can do. It might take a year or more to get back to your previous level of performance. Your physiotherapist or doctor will give you more advice specific to you.

You may need to take time off work to allow the tendon to heal. How long you need to take off will vary depending on a number of things. These include the type of treatment you’ve had, how mobile you were previously, what job you do and any restrictions at your workplace. Your doctor will be able to give you specific advice.

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.