Achilles Tendon Rupture
An Achilles tendon rupture is a tear of the large tendon at the back of the ankle, which connects the calf muscles to the heel bone. It usually occurs suddenly during activities that involve running, jumping, or sudden acceleration, such as tennis, basketball, or football.
Causes
An Achilles tendon rupture most commonly occurs in:
- Active adults aged 30–60 years
- Sports involving sprinting, jumping, or sudden direction changes
- People with tight calf muscles or reduced flexibility
- Those taking certain antibiotics or steroid medications, which can weaken tendons
Anatomy
The Achilles tendon is the strongest tendon in the body. It joins the gastrocnemius and soleus muscles in the calf to the calcaneus (heel bone) and allows you to push off when walking, running, or climbing stairs. A rupture occurs when the tendon fibres tear completely or partially, often during a sudden, forceful movement.
Achilles Tendon Rupture
Symptoms
Typical symptoms include:
- A sudden “pop” or snapping sensation in the back of the ankle
- Sharp pain, followed by difficulty walking or pushing off the foot
- Swelling and bruising around the heel and calf
- A visible gap or indentation above the heel
- Weakness when trying to stand on tiptoes
Diagnosis
Your doctor will examine the leg and may perform a Thompson test — squeezing the calf while observing for ankle movement.
- Investigations may include:
- Ultrasound or MRI scan to confirm the tear and assess its severity
Treatment
Treatment depends on your age, activity level, and the extent of the rupture:
- Non-surgical treatment involves wearing a boot with the foot pointed downward to bring the tendon ends together, followed by a structured rehabilitation program. If this is started within days of the injury it can be very effective.
- Surgical repair may be recommended for active individuals or complete ruptures, where the torn ends are stitched together.
- Surgery aims to reduce the risk of re-rupture and restore full strength, however, then carries the risks associated with surgery.
Recovery
Recovery usually takes 6–12 months, depending on treatment and activity goals.
- Walking in a boot starts within the first few weeks.
- Physiotherapy focuses on regaining movement, balance, and calf strength.
- Gradual return to sport or high-impact activity is typically possible after 6–9 months.
Possible Complications
While most people recover well, potential issues can include:
- Weakness or tightness in the calf
- Re-rupture of the tendon
- Infection or wound problems (after surgery)
- Numbness or discomfort around the scar
- Prolonged stiffness or swelling
- Blood clots
When to Seek Help
Seek medical attention urgently if you experience:
- A sudden pop or sharp pain at the back of the ankle
- Difficulty walking or standing on tiptoes
- Swelling or bruising after a sporting movement
