The Achilles tendon is commonly injured during activities such as basketball, pickleball, tennis, hiking, and running. While Achilles tendonitis and tendinosis typically develop gradually over time, an Achilles tendon rupture is a sudden injury that often requires urgent medical evaluation.
Patients frequently describe hearing a pop or feeling as though they were kicked in the back of the leg. Because treatment decisions are often made shortly after injury, prompt evaluation is important.
What Is the Achilles Tendon?
A tendon is a band of tissue that connects a muscle to a bone. The Achilles tendon runs down the back of the lower leg and connects the calf muscle to the heel bone. Also called the heel cord, the Achilles tendon facilitates walking by helping to raise the heel off the ground.
What Is an Achilles Tendon Rupture?
An Achilles tendon rupture is a complete or partial tear that occurs when the tendon is stretched beyond its capacity. Forceful jumping or pivoting, or sudden accelerations of running, can overstretch the tendon and cause a tear. An injury to the tendon can also result from falling or tripping.
Achilles tendon ruptures are most often seen in “weekend warriors”—typically, middle-aged people participating in sports in their spare time. Less commonly, illness or medications, such as steroids or certain antibiotics, may weaken the tendon and contribute to ruptures.
An acute Achilles tendon rupture should not be mistaken for a simple ankle sprain. Although some patients are still able to walk after the injury, they often have significant weakness when pushing off the foot or standing on their toes.
Early diagnosis and treatment are important because delays may complicate management.
Signs & Symptoms
A person with a ruptured Achilles tendon may experience one or more of the following:
- Sudden pain (which feels like a kick or a stab) in the back of the ankle or calf—often subsiding into a dull ache
- A popping or snapping sensation
- Swelling on the back of the leg between the heel and the calf
- Difficulty walking (especially upstairs or uphill) and difficulty rising up on the toes
If you experience a sudden pop, loss of push-off strength, difficulty standing on your toes, or the sensation of being kicked in the back of the leg, seek prompt medical evaluation.
These symptoms require prompt medical attention to prevent further damage. Until the patient is able to see a doctor, the RICE method should be used. This involves:
- Rest. Stay off the injured foot and ankle, since walking can cause pain or further damage.
- Ice. Apply a bag of ice covered with a thin towel to reduce swelling and pain. Do not put ice directly against the skin.
- Compression. Wrap the foot and ankle in an elastic bandage to prevent further swelling.
- Elevation. Keep the leg elevated to reduce the swelling. It should be even with or slightly above heart level.
Many patients are surprised to learn that they may still be able to walk despite a complete Achilles tendon rupture. However, the ability to walk does not rule out a serious tendon injury.
Because an Achilles tendon rupture is a time-sensitive injury, patients should seek medical evaluation as soon as possible. Emergency department evaluation is often appropriate for acute ruptures because immobilization, imaging, and consultation with an on-call foot and ankle or orthopedic surgeon can frequently be arranged without delay.
Diagnosis
In diagnosing an Achilles tendon rupture, the foot and ankle surgeon will ask questions about how and when the injury occurred and whether the patient has previously injured the tendon or experienced similar symptoms. The surgeon will examine the foot and ankle, feeling for a defect in the tendon that suggests a tear. Range of motion and muscle strength will be evaluated and compared to the uninjured foot and ankle. If the Achilles tendon is ruptured, the patient will have less strength in pushing down (as on a gas pedal) and will have difficulty rising on the toes.
The diagnosis of an Achilles tendon rupture is typically straightforward and can be made through this type of examination. In some cases, however, the surgeon may order an MRI or other advanced imaging tests.
Treatment
Treatment options for an Achilles tendon rupture include both surgical and nonsurgical approaches. For newly ruptured Achilles tendons, treatment decisions are often made shortly after injury. Prompt evaluation by a foot and ankle specialist or orthopedic surgeon is recommended.
Nonsurgical Treatment
Nonsurgical treatment, which is generally associated with a higher rate of rerupture, is selected for minor ruptures, less active patients and those with medical conditions that prevent them from undergoing surgery. Nonsurgical treatment involves use of a cast, walking boot or brace to restrict motion and allow the torn tendon to heal.
Surgery
For many active patients with a newly ruptured Achilles tendon, surgical repair may be recommended to restore tendon continuity and maximize strength and function. Besides decreasing the likelihood of rerupturing the Achilles tendon, surgery often increases the patient’s push-off strength and improves muscle function and movement of the ankle.
Various surgical techniques are available to repair the rupture. The surgeon will select the procedure best suited to the patient.
Following surgery, the foot and ankle are initially immobilized in a cast or walking boot. The surgeon will determine when the patient can begin weightbearing.
Complications such as incision-healing difficulties, rerupture of the tendon or nerve pain can arise after surgery.
Physical Therapy
Whether an Achilles tendon rupture is treated surgically or nonsurgically, physical therapy is an important component of the healing process. Physical therapy involves exercises that strengthen the muscles and improve range of motion in the foot and ankle.
When Should You Seek Immediate Medical Attention?
A sudden Achilles tendon rupture is often best evaluated urgently.
Seek prompt medical attention if you experience:
– A sudden pop in the back of the ankle or calf
– The sensation that someone kicked you from behind
– Sudden loss of push-off strength
– Inability to stand on your toes
– Significant difficulty walking after a sports injury
Early diagnosis helps ensure appropriate treatment and may improve outcomes.
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