Achilles Tendon Rupture / Tear

Achilles Tendon Rupture

What Causes an Achilles Tendon Rupture?

When your Achilles tendon tears fully it is called an Achilles tendon rupture.

Often an Achilles rupture can occur “just like that” (spontaneously) without any prodromal symptoms. Unfortunately the first “pop” or “snap” that you hear, feel and experience is your Achilles tendon rupture.

Achilles tendon rupture most commonly occurs in the middle-aged male athlete (the weekend warrior who is engaging in a pickup game of basketball, for example). Injury often occurs during recreational sports that require bursts of

  • jumping
  • pivoting and
  • running

Most often these are tennis, racquetball, squash, basketball, soccer, softball and badminton.

Achilles rupture can (and unfortunately, often) happen in these situations:

  • making a forceful push-off with foot while your knee is straightened by the powerful thigh muscles. One example might be starting a foot race or jumping.
  • sudden trip or stumble, and foot is thrust in front to break a fall, forcefully overstretching the tendon.
  • falling from a significant height.

The biggest risk factor for Achilles tendon rupture is tendon cell death which occurs as a result of poorly managed tendinopathy

(Related Article: What is a Tendinopathy)

Higher Risk of Achilles Tendonitis History

It does appear that previous history of Achilles tendonitis results in a degenerative tendon, which with time, age and sedentary lack of use, may lead to weakening and thinning of the Achilles tendon.

If/when that happens, then the weakened/compromised Achilles tendon becomes prone to injury or rupture.

To add to that, certain illnesses (such as arthritis and diabetes) and medications (such as corticosteroids and some antibiotics) can also increase the risk of tendon rupture.

Achilles Tendon Diagnosis

Unfortunately there is a whole staggering 20%-30% of Achilles tendon ruptures are totally missed.

Thompson (calf squeeze) test is 96% sensitive and 93% sensitive. Unfortunately, some health practitioners fail to perform this simple clinical test (due to being overworked, overwhelmed or just simply missed it).

A simple ultrasound examination or an MRI can confirm an Achilles tendon rupture. Often, it can be clearly seen movement and testing wise, but it’s always better to have visual imaging to guide.

Totally Ruptured Achilles Tendon Treatment

Treatment of a ruptured Achilles tendon is either

  • conservative (non-operative) in a Controlled Motion Ankle (CAM) Boot or
  • it may require corrective surgery

The current consensus based on research is to treat them conservatively since the functional outcome and chance of re-rupture is similar (7% to 15%) using both approaches but surgical intervention has a higher risk of infection.

Achilles tendon surgery is usually considered if your Achilles has re-ruptured or there is a delay of two weeks between the rupture and the diagnosis and commencement of conservative bracing and treatment.

Post-Surgical Physiotherapy

Most sports and orthopedic surgeons will recommend that you commence physiotherapy about one-week post-op.

Of course, it is important to not to over-stress your Achilles tendon repair. Professional guidance of a physiotherapist experienced in Achilles tendon rupture rehabilitation is strongly recommended for your best ankle and clinical outcomes.

Ruptured Achilles Tendon Prognosis

You will normally be in your Controlled Motion Ankle (CAM) Boot or brace for about 6 to 12 weeks. In some cases, shorter or longer, depending on the healing of the torn Achilles tendon.

If everything goes perfectly during your rehabilitation it takes at least 12 weeks (3 months) before a return to sport is possible.

That being said, if there are complications, some Achilles tendon repairs can take up to six months to rehabilitate successfully and return to sports.

Seek Professional Advice

The best advice is to seek early advice from your physiotherapist, doctor or orthopaedic surgeon. Delay often result in a poorer prognosis.

If you are lucky, you may avoid surgery but require a walking boot, or similar, with a graduated rehabilitation program to strengthen your injured tendon and prevent a further injury.