Achilles Tendon Rupture Treatment
The Achilles tendon, which attaches to the heel, can rupture during sudden strain. It is treated surgically or with a special boot; the goal is for the tendon to heal at the right length.
The Achilles tendon connects the calf muscles to the heel bone and is the thickest and strongest tendon in the body. It lets us push off when walking, running and jumping. Achilles tendon rupture is most common between the ages of 30 and 50, in people who play sport irregularly.
How does it rupture?
Rupture usually happens during sudden acceleration, a jump or a change of direction. Basketball, football, tennis, badminton and five-a-side football are frequent causes. Previous wear of the tendon, steroid injections and some antibiotics can increase the risk.
Symptoms
- Sudden pain at the back of the heel, as if kicked or hit by a stone
- Sometimes a snapping sound
- Inability to rise onto the toes, weakness pushing off
- A gap felt a few centimetres above the heel
- Swelling and bruising
Some patients underestimate the injury because they can still walk. Being able to walk does not mean the tendon is intact.
Diagnosis
The diagnosis is usually made on examination. If squeezing the calf while the patient lies face down does not move the foot downwards (the Thompson test), the tendon is ruptured. Ultrasound or MRI can show the site of the rupture and the gap between the ends.
Treatment options
Non-surgical (functional) treatment
Suitable patients are treated with a special boot that holds the foot pointing downwards, with heel wedges. The heel height is reduced over the weeks and controlled weight bearing starts early. Success depends on starting treatment early and following the protocol closely.
Surgical treatment
Surgery may be recommended for active athletes, late presentations and ruptures with a large gap between the ends. The ends are stitched through open or small-incision (minimally invasive) techniques. In neglected ruptures, the tendon may need to be lengthened or reinforced with a nearby tendon.
Recovery
- First weeks: Boot with heel wedges, controlled weight bearing
- Weeks 6-8: Gradually leaving the boot, more intensive physiotherapy
- Months 3-4: Strengthening, preparation for light running
- After month 6: Gradual return to sport once strength is adequate
The calf muscle takes time to regain its strength and needs regular exercise.
Protecting the Achilles tendon
Starting sport regularly and gradually, warming up well, and stretching and strengthening the calf muscles protect the Achilles tendon. Joining weekend matches unprepared after a long break is one of the main situations that increase the risk of rupture. Recurrent pain in the Achilles area should be assessed for tendon wear.
Frequently asked questions
Is surgery or a boot better?
Both work well in the right patient. The choice is made together, based on age, activity level, timing and the condition of the tendon ends.
I can walk. Could it still be ruptured?
Yes. Other muscles can make walking possible. It is important to be examined after sudden heel pain.
Can the tendon rupture again?
The risk of re-rupture is low, but early, uncontrolled loading increases it. Following the rehabilitation protocol is important.
Will there be a scar after Achilles surgery?
Open surgery leaves a scar at the back of the heel; small-incision techniques leave smaller scars. In the first weeks, care is taken that shoes and the boot do not press on the wound.
The information on this page is general and does not replace an examination. An examination is needed to decide which treatment suits you.