The Achilles tendon is a robust band of fibrous tissue that connects the calf muscles—specifically the gastrocnemius and soleus muscles—to the calcaneus, or heel bone.

Measuring approximately 15 centimeters in length, the Achilles tendon is the thickest and strongest tendon in the body, capable of withstanding forces up to 12.5 times a person’s body weight during activities like running and jumping.

The primary function of the Achilles tendon is to facilitate movement of the foot and ankle by transmitting the force generated by the calf muscles to the heel bone. This action is critical for plantarflexion—the movement that allows you to push your foot down, such as when standing on your toes or propelling yourself forward during walking, running, or jumping.

The Achilles tendon also plays a vital role in absorbing shock and providing stability to the ankle during movement. Its elastic properties allow it to store and release energy, contributing to the efficiency of locomotion. Given its central role in movement, any damage to the Achilles tendon can severely impact mobility and function.

An Achilles tendon rupture is often a sudden and painful event, typically accompanied by several hallmark symptoms. Common signs and symptoms of an Achilles tendon rupture include:

1. A “Pop” Sound or Sensation: Many people report hearing or feeling a “pop” at the moment of injury. This sensation often feels like being struck in the back of the ankle, even though no external impact occurs. This popping sound or sensation is a key indicator of a complete tear of the Achilles tendon.
2. Sudden, Severe Pain: The pain from an Achilles rupture is typically intense and immediate, often described as a sharp or burning pain in the back of the ankle or lower leg. This pain usually subsides somewhat after the initial injury but may remain significant, especially when attempting to move the foot.
3. Swelling and Bruising: Swelling around the ankle and lower leg develops quickly following an Achilles rupture. Bruising may also appear, often spreading downward toward the foot due to gravity. The swelling and bruising are caused by internal bleeding and inflammation in response to the injury.
4. Inability to Walk Properly: Most people with a ruptured Achilles tendon will have difficulty walking, especially pushing off the ground with the affected foot. The lack of power in the foot and ankle is due to the complete loss of connection between the calf muscles and the heel, making it challenging to bear weight or push off when taking a step.
5. Limited Range of Motion: After an Achilles rupture, the ability to move the foot, particularly to point the toes downward (plantarflexion), is significantly impaired. This limitation occurs because the tendon is no longer connected to the muscles that facilitate this movement.
6. Visible Deformity: In some cases, a gap or indentation may be visible just above the heel where the tendon has ruptured. This deformity is often easier to see or feel when the foot is relaxed, as the ends of the torn tendon may retract and create a noticeable gap under the skin.

Recognising an Achilles rupture involves understanding the context of the injury, the symptoms experienced, and conducting some basic physical tests. If you suspect an Achilles rupture, here’s what to consider:

Injury Context: Achilles tendon ruptures often occur during activities that involve a sudden push-off movement, such as jumping, sprinting, or suddenly changing direction. They can also occur after a fall or a misstep, particularly if the individual lands awkwardly with the foot in a dorsiflexed position (toes pointing upward).

Physical Examination: A healthcare professional will typically begin with a physical examination, including a visual assessment of the affected area, palpation (feeling) for gaps or abnormalities in the tendon, and performing the Thompson test. The physical exam can often diagnose a rupture with high confidence, especially when combined with a thorough history of how the injury occurred.

Ultrasound: Ultrasound is a non-invasive imaging technique that can be used to confirm an Achilles tendon rupture. It provides real-time images of the soft tissues, allowing the examiner to see the extent of the tear and the condition of the surrounding structures. Ultrasound is particularly useful for identifying partial ruptures or assessing the tendon for any remaining connection between the torn ends.

Magnetic Resonance Imaging (MRI): MRI is another imaging tool that provides detailed pictures of the soft tissues, including the Achilles tendon. It is particularly useful for evaluating the extent of the rupture, identifying any associated injuries, and planning for surgical repair if necessary. MRI is often used when the diagnosis is unclear or when a complex or chronic rupture is suspected.

For some individuals, especially those who are less physically active or have partial ruptures, non-surgical treatment can be an effective option. This approach typically involves:

Immobilisation: The affected leg is immobilized using a cast, boot, or brace to keep the foot in a plantarflexed position (toes pointing downward). This position brings the torn ends of the Achilles tendon closer together, promoting natural healing. Immobilisation is usually maintained for 8-10 weeks, gradually allowing the tendon to heal and reattach itself.

Functional Rehabilitation: Following the period of immobilisation, a structured rehabilitation program begins. This includes physical therapy focused on restoring range of motion, strength, and flexibility in the calf muscles and Achilles tendon. Exercises are introduced gradually, starting with gentle stretching and progressing to more intense strengthening and balance exercises.

Advantages and Considerations: Non-surgical treatment avoids the risks associated with surgery, such as infection or complications from anaesthesia. However, there is a slightly higher risk of re-rupture compared to surgical treatment, and the recovery process can be longer. This option is generally more suitable for older individuals, those with medical conditions that make surgery risky, or those with partial ruptures.

Surgical intervention is often recommended for younger, more active individuals, or in cases of complete ruptures where the tendon ends are significantly separated. Surgery aims to reattach the torn ends of the tendon to restore its function.

Advantages and Considerations:

Surgical repair significantly reduces the risk of re-rupture compared to non-surgical treatment and generally allows for a faster return to high levels of physical activity. However, surgery carries inherent risks, including infection, nerve damage, and complications related to anaesthesia.

Regardless of the type of surgery, post-surgical care is crucial for successful recovery. The timeline for returning to normal activities varies depending on the individual and the severity of the rupture. Most people can resume low-impact activities within a few months, but it may take 6 to 12 months to return to high-impact sports or strenuous physical activity.

The recovery timeline for an Achilles tendon rupture varies depending on the severity of the injury, the treatment method, and the individual’s overall health and adherence to rehabilitation. Typical milestones include:

Weeks 0-4: Immobilization and non weight-bearing in a cast.

Weeks 4-12: Transition to partial and then full weight-bearing. Initially weight bearing in an air boot and then in a trainer. Introduction of strengthening and flexibility exercises.

Months 3-6: Continued strengthening, balance, and agility training. Progression to more intense physical activity.

Months 6-12: Gradual return to sport-specific activities. Full recovery and return to pre-injury levels of activity may take up to a year, particularly for high-impact sports.