What Is an Achilles Tendon Rupture?
Tendons are connective tissues that attach muscles to bones. The Achilles tendon, the largest and strongest tendon in the human body, connects the calf muscles to the heel bone. It plays a crucial role in activities such as walking, running, and jumping.
An Achilles tendon rupture can occur suddenly during sports or physical activities, especially those involving abrupt stops, twists, or directional changes. These high-impact forces can exert stress on the tendon up to 6 to 12 times the body weight. For example, a person weighing 70 kg may subject their Achilles tendon to as much as 700 kg of force. While the tendon is extremely strong, sprains, missteps, or falls during daily activities can still lead to partial or complete tears.
Most ruptures occur 2–6 cm above the heel bone, an area that naturally has poor blood circulation, making it more vulnerable to injury.
Risk Factors for Achilles Tendon Injury
- Gender: Men are six times more likely than women to suffer from Achilles tendon ruptures, possibly due to the protective effects of estrogen and greater muscle mass in men leading to stronger contractions.
- Age: Blood flow to the tendon decreases with age, increasing the risk. Ruptures are most common in individuals aged 30–45.
- Chronic Conditions: Diseases like diabetes, thyroid disorders, gout, and rheumatoid arthritis can weaken tendons, making them prone to rupture.
- Steroid Injections: Steroid treatments for ankle pain or swelling may weaken the Achilles tendon.
- Obesity: Excess body weight increases the load on the tendon, raising the risk of tears.
- Antibiotics: Some antibiotics, such as fluoroquinolones, have been linked to a higher risk of tendon rupture.
Symptoms of Achilles Tendon Rupture
Most people describe feeling a sudden, sharp pain—as if being kicked or hit in the calf—at the moment of rupture. A “popping” sound may also be heard. Additional symptoms include:
- Swelling and bruising around the heel
- A noticeable gap or indentation in the tendon
- Inability to stand on tiptoe on the affected leg
- Difficulty pushing off the foot while walking
Diagnosis of Achilles Tendon Rupture
Diagnosis involves a physical examination and imaging tests:
- Physical Exam: Your doctor will check for swelling, tenderness, and the presence of a tendon gap. The Thompson Test is commonly used—when the calf is squeezed, the foot should naturally move. If there’s no movement, a rupture is likely.
- MRI and Ultrasound: These are used to confirm the severity and location of the rupture.
Treatment Options for Achilles Tendon Rupture
Treatment is categorized into non-surgical and surgical methods, depending on the location of the rupture, the patient’s age, and lifestyle expectations.
Non-Surgical Treatment
Non-operative treatments may include:
- Walking boot or cast to immobilize the ankle and bring the tendon ends together
- 6–12 weeks of rest to promote healing
- Cold therapy to reduce swelling and prescribed medications for pain
- Proper nutrition to support tissue recovery
- After immobilization, a physical therapy program is critical for restoring range of motion and muscle strength
Surgical Treatment
Surgery is typically recommended for more severe ruptures or for patients with high activity levels. The procedure involves reconnecting the torn tendon ends. Post-surgery, the ankle is immobilized with a cast. The patient must avoid putting weight on the foot for a prescribed period.
Following cast removal:
- Transition to a walking boot with partial weight-bearing
- Initiate physical therapy to regain strength and mobility
A tailored rehabilitation plan ensures a safe return to daily activities