Acute Rupture of the Achilles Tendon
Topics Covered on this page
The Achilles tendon is at the back of the heel.It joins the heel bone to the calf muscle.Its function is to lift the back of the heel off the ground in walking, running and jumping.
The Achilles tendon can be ruptured , or torn, by sudden force on the foot or ankle. If your Achilles tendon is ruptured you will be unable to stand on tiptoe, and will have a flat footed walk. It is important to diagnose and treat this injury as soon as possible, to help promote healing. Treatment usually involves initially wearing a plaster cast and then a functional brace for several months, and possibly having an operation in addition
What is the treatment for a ruptured Achilles tendon?This condition should be diagnosed and
Which treatment is best?
There is debate as to which treatment is best: surgery or conservative treatment. This section summarises the research into treatment of Achilles tendon rupture.
Most of the research so far found that surgery has one advantage: it reduces the risk that the Achilles tendon will rupture again later (a problem known as re-rupture). The disadvantages of surgery are the risk of complications such as wound infection (see below), and the need for an an operation.
For this reason, surgery may be recommended for younger people or those doing sports. Conservative treatment may be suggested for older or less active people, and for people wishing to avoid surgery. But the choice of treatment depends on individual preference and circumstances. Surgery may also be recommended if there has been a delay in starting treatment.
However, more new pieces of research are finding that surgery and conservative treatment actually gave equally good results, when patients were also given early mobilisation treatment using a brace.
After surgery, a brace seems to be better than a plaster cast in terms of faster recovery and return to normal activities, a lower complication rate and patient preferences.
What is the outlook for a ruptured Achilles tendon?Generally, the outlook is good. However, the tendon does take time to heal, usually about eight to ten weeks. More time will be needed after this to allow the muscles to regain their normal strength after being in a plaster or brace. Depending on the type of work, some people need several weeks off work after an Achilles tendon rupture, and the time taken to return to sport is between 4 and 12 months.
Possible complications are as follows:
- What is Achilles tendon rupture?
- What causes a ruptured Achilles tendon?
- How common is Achilles tendon rupture?
- What are the symptoms of Achilles tendon rupture?
- How is an Achilles tendon rupture diagnosed?
- What else could it be?
- What is the treatment for a ruptured Achilles tendon?
- What is the outlook for a ruptured Achilles tendon?
- Can Achilles tendon rupture be prevented?
- References
The Achilles tendon is at the back of the heel.It joins the heel bone to the calf muscle.Its function is to lift the back of the heel off the ground in walking, running and jumping.
The Achilles tendon can be ruptured , or torn, by sudden force on the foot or ankle. If your Achilles tendon is ruptured you will be unable to stand on tiptoe, and will have a flat footed walk. It is important to diagnose and treat this injury as soon as possible, to help promote healing. Treatment usually involves initially wearing a plaster cast and then a functional brace for several months, and possibly having an operation in addition
What is the treatment for a ruptured Achilles tendon?This condition should be diagnosed and
Which treatment is best?
There is debate as to which treatment is best: surgery or conservative treatment. This section summarises the research into treatment of Achilles tendon rupture.
Most of the research so far found that surgery has one advantage: it reduces the risk that the Achilles tendon will rupture again later (a problem known as re-rupture). The disadvantages of surgery are the risk of complications such as wound infection (see below), and the need for an an operation.
For this reason, surgery may be recommended for younger people or those doing sports. Conservative treatment may be suggested for older or less active people, and for people wishing to avoid surgery. But the choice of treatment depends on individual preference and circumstances. Surgery may also be recommended if there has been a delay in starting treatment.
However, more new pieces of research are finding that surgery and conservative treatment actually gave equally good results, when patients were also given early mobilisation treatment using a brace.
After surgery, a brace seems to be better than a plaster cast in terms of faster recovery and return to normal activities, a lower complication rate and patient preferences.
What is the outlook for a ruptured Achilles tendon?Generally, the outlook is good. However, the tendon does take time to heal, usually about eight to ten weeks. More time will be needed after this to allow the muscles to regain their normal strength after being in a plaster or brace. Depending on the type of work, some people need several weeks off work after an Achilles tendon rupture, and the time taken to return to sport is between 4 and 12 months.
Possible complications are as follows:
- Whichever treatment option is used, there is a chance that the Achilles tendon will not heal fully, and further treatment such as surgery may be needed.
- Complications of surgery: these are usually minor complications such as a wound infection or reduced sensation near the operation site. About 4 in 100 people get a wound infection following surgery to fix a ruptured Achilles tendon.
- The tendon may scar or may become shorter during the healing process.
- There is also a chance that the tendon could re-rupture (get torn again later). According to some research, the risk of a re-rupture is about 4 in 100 with surgical treatment and about 12 in 100 with conservative treatment.
- For sports, start with warm-up exercises.
- Corticosteroid (steroid) medication such as prednisolone, should be used carefully and the dose should be reduced if possible. But note that there are many conditions where corticosteroid medication is important or lifesaving.
- Quinolone antibiotics should be used carefully in people aged over 60 or who are taking steroids.
What causes a ruptured Achilles tendon?
As with any muscle or tendon in the body, the Achilles tendon can be torn if there is a high force or stress on it. This can happen with activities which involve a rapid and forceful push off with the foot - for example, in football, running, basketball, diving, and tennis.
There is some evidence that rupture may occur as the calf muscle contracts whilst the foot actually dorsiflexes (bends upwards) such as may occur when a step is misjudged
Many times the Achilles tendon is probably already slightly diseased and weakened, making it more likely to rupture. This fits in with the statistic that most ruptures of this tendon occur in 'middle age'.
Other factors that may weaken the Achilles tendon are:
As with any muscle or tendon in the body, the Achilles tendon can be torn if there is a high force or stress on it. This can happen with activities which involve a rapid and forceful push off with the foot - for example, in football, running, basketball, diving, and tennis.
There is some evidence that rupture may occur as the calf muscle contracts whilst the foot actually dorsiflexes (bends upwards) such as may occur when a step is misjudged
Many times the Achilles tendon is probably already slightly diseased and weakened, making it more likely to rupture. This fits in with the statistic that most ruptures of this tendon occur in 'middle age'.
Other factors that may weaken the Achilles tendon are:
- Corticosteroid medication (such as prednisolone) - mainly if it is used as long-term treatment rather than a short course.
- Corticosteroid injection near the Achilles tendon. (the evidence suggests that the likelihood of causing a tear greatly increases after three injections)
- Certain rare medical conditions, such as Cushing's syndrome, where the body makes too much of its own corticosteroid hormones.
- Increasing age.
- Tendonitis (inflammation) of the Achilles tendon.
- Other medical conditions which have a general weakening effect on connective tissue including tendons . For example, rheumatoid arthritis, gout and systemic lupus erythematosus (SLE).
- Certain antibiotics may slightly increase the risk of having an Achilles tendon rupture. These are the quinolone antibiotics such as ciprofloxacin and ofloxacin.
How common is Achilles tendon rupture?
It affects about 1 in 5,000 people at any one time. It can occur at any age but is most common in people between the ages of 30 and 50.
It affects about 1 in 5,000 people at any one time. It can occur at any age but is most common in people between the ages of 30 and 50.
What are the symptoms of Achilles tendon rupture?
You may notice the symptoms come on suddenly during a sporting activity or injury. It is very common to feel as if you have been kicked hard at the back of the heel when the achilles tendon snaps. This may be associated with an audible snap.The sharp pain usually settles within a few hours to days, although there may be some aching at the back of the lower leg. After the injury, the usual symptoms are:
Note: an Achilles tendon rupture is sometimes difficult to diagnose and can be missed on first assessment. It is important for both doctors and patients to be aware of this and to look carefully for an Achilles tendon rupture if it is suspected.
You may notice the symptoms come on suddenly during a sporting activity or injury. It is very common to feel as if you have been kicked hard at the back of the heel when the achilles tendon snaps. This may be associated with an audible snap.The sharp pain usually settles within a few hours to days, although there may be some aching at the back of the lower leg. After the injury, the usual symptoms are:
- A flat footed type of walk. You can walk and bear weight, but cannot push of the ground properly on the side where the tendon is ruptured.
- Inability to stand on tiptoe.
- If the tendon is completely torn, you may feel a gap just above the back of the heel. However, if there is bruising then the swelling may disguise the gap.
Note: an Achilles tendon rupture is sometimes difficult to diagnose and can be missed on first assessment. It is important for both doctors and patients to be aware of this and to look carefully for an Achilles tendon rupture if it is suspected.
How is an Achilles tendon rupture diagnosed?
The diagnosis is usually made on the basis of symptoms, the history of the injury and a doctor's examination.
The doctor may look at your walking and observe whether you can stand on tiptoe. She/he may test the tendon using a method called Thompson's test (also known as the calf squeeze test). In this test, you will be asked to lie face down on the examination bench and to bend your knee. The doctor will gently squeeze the calf muscles at the back of your leg, and observe how the ankle moves. If the Achilles tendon is OK, the calf squeeze will make the foot point briefly away from the leg (a movement called plantar flexion). This is quite an accurate test for Achilles tendon rupture.
If the diagnosis is uncertain, an ultrasound or MRI scan may help.
Note: an Achilles tendon rupture is sometimes difficult to diagnose and can be missed on first assessment. It is important for both doctors and patients to be aware of this and to look carefully for an Achilles tendon rupture if it is suspected.
The diagnosis is usually made on the basis of symptoms, the history of the injury and a doctor's examination.
The doctor may look at your walking and observe whether you can stand on tiptoe. She/he may test the tendon using a method called Thompson's test (also known as the calf squeeze test). In this test, you will be asked to lie face down on the examination bench and to bend your knee. The doctor will gently squeeze the calf muscles at the back of your leg, and observe how the ankle moves. If the Achilles tendon is OK, the calf squeeze will make the foot point briefly away from the leg (a movement called plantar flexion). This is quite an accurate test for Achilles tendon rupture.
If the diagnosis is uncertain, an ultrasound or MRI scan may help.
Note: an Achilles tendon rupture is sometimes difficult to diagnose and can be missed on first assessment. It is important for both doctors and patients to be aware of this and to look carefully for an Achilles tendon rupture if it is suspected.
What else could it be?
Similar symptoms can be caused by Achilles tendonitis (inflammation of the Achilles tendon), a strain or tear of the calf muscles, thrombosis of a deep vein in the calf and arthritis of the ankle.
Similar symptoms can be caused by Achilles tendonitis (inflammation of the Achilles tendon), a strain or tear of the calf muscles, thrombosis of a deep vein in the calf and arthritis of the ankle.
This video leans towards operative treatment but opinion is divided as to the best forms of treatment.
Whilst there is a wealth of literature showing that traditional treatment in a plaster cast is inferior to operative treatment, recent papers have shown excellent results with a non operative regime using functional bracing
Whilst there is a wealth of literature showing that traditional treatment in a plaster cast is inferior to operative treatment, recent papers have shown excellent results with a non operative regime using functional bracing
What is the treatment for a ruptured Achilles tendon?
This condition should be diagnosed and treated as soon as possible, because prompt treatment probably improves recovery. You may need to be referred urgently to see a doctor in an orthopaedic department or accident and emergency department. Meanwhile, if a ruptured Achilles tendon is suspected, you should not put any weight on that foot, so do not walk on it at all.
What are the treatment options?There are two options for treatment. One option is an operation to surgically repair the tendon. The surgeon sews together the torn ends of the Achilles tendon, and perhaps may also use another tendon or a tendon graft to help with the repair. A plaster cast or brace is needed after the operation.
The other option is to allow time for the tendon to heal naturally, resting it in a brace or plaster cast. This is called conservative treatment. If the tendon does not heal on its own, a surgical repair can then be done later.
Both options will involve having a plaster cast or brace (orthosis) for about eight weeks, to protect the tendon while it heals. The plaster or brace is positioned so that the foot is pointing slightly downwards, which takes the strain off the tendon.
Traditionally, crutches were used to keep weight off the leg during the first few weeks of treatment. Now there is a trend towards early mobilisation. This involves fitting a plaster or brace which you can walk on. It is more convenient because you do not need to use crutches.
Physiotherapy is often provided as well.
This condition should be diagnosed and treated as soon as possible, because prompt treatment probably improves recovery. You may need to be referred urgently to see a doctor in an orthopaedic department or accident and emergency department. Meanwhile, if a ruptured Achilles tendon is suspected, you should not put any weight on that foot, so do not walk on it at all.
What are the treatment options?There are two options for treatment. One option is an operation to surgically repair the tendon. The surgeon sews together the torn ends of the Achilles tendon, and perhaps may also use another tendon or a tendon graft to help with the repair. A plaster cast or brace is needed after the operation.
The other option is to allow time for the tendon to heal naturally, resting it in a brace or plaster cast. This is called conservative treatment. If the tendon does not heal on its own, a surgical repair can then be done later.
Both options will involve having a plaster cast or brace (orthosis) for about eight weeks, to protect the tendon while it heals. The plaster or brace is positioned so that the foot is pointing slightly downwards, which takes the strain off the tendon.
Traditionally, crutches were used to keep weight off the leg during the first few weeks of treatment. Now there is a trend towards early mobilisation. This involves fitting a plaster or brace which you can walk on. It is more convenient because you do not need to use crutches.
Physiotherapy is often provided as well.
The Authors preferred regime
The aim of any treatment is to oppose the torn tendon ends and so allow them to heal with maximum strength and function.
If the injury is diagnosed promptly a dynamic ultrasound examination shows clearly whether the tendon ends come together or are held apart by bloodclot.
If the ends are held apart I recommend surgical repair.
If the ends come together with the foot pointing down I recommend Functional bracing
If the injury is diagnosed promptly a dynamic ultrasound examination shows clearly whether the tendon ends come together or are held apart by bloodclot.
If the ends are held apart I recommend surgical repair.
If the ends come together with the foot pointing down I recommend Functional bracing
Ongoing Treatment for Achilles Tendon Rupture
Whether treated with an operation or not you will require 10 to 12 weeks using a functional brace. This allows ankle movement in a controlled way whilst protecting the torn tendon.
Studies have shown that this can lead to a stronger and less bulky repair than with more traditional splinting.
Return to sports will be at least 6 months and full recovery will take up to 18 months
What is a functional Brace?
This is a type of splint that will prevent your ankle from bending up, so protecting the healing tendon, whilst at the same time allowing active pointing of the toes (plantar flexion)
This has been shown to strengthen tendon healing and give a more normal feeling, less bulky tendon repair with a slightly faster return to activity than with traditional cast immobilisation
Studies have shown that this can lead to a stronger and less bulky repair than with more traditional splinting.
Return to sports will be at least 6 months and full recovery will take up to 18 months
What is a functional Brace?
This is a type of splint that will prevent your ankle from bending up, so protecting the healing tendon, whilst at the same time allowing active pointing of the toes (plantar flexion)
This has been shown to strengthen tendon healing and give a more normal feeling, less bulky tendon repair with a slightly faster return to activity than with traditional cast immobilisation