Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Achilles Tendon Rupture

(Rupture, Achilles Tendon; Severely Torn Achilles Tendon)
Pronounced: ah-KILL-ees TEN-dun RUP-choor
by Mary Cresse
Definition

The Achilles tendon connects the calf muscles to the heel bone. A rupture, or tear, can occur when the tendon is overstretched. This injury is very painful. You may hear a popping or snapping noise when the tendon is torn.

Causes

Achilles tendon rupture can be caused by:

  • Too much stress placed on the tendon, common during:
    • Lunging, jumping, twisting (eg, basketball, football, rugby)
    • Running, especially on hills, stairs, and hard surfaces
  • Having an accident where the tendon is cut or mangled (less common)
  • Overworking an inflamed tendon
  • Weakened tendon that has not fully healed from previous injury, use of medication, or disease
Risk Factors

These factors increase your chance of developing Achilles tendon rupture:

  • Collagen vascular disease (eg, rheumatoid arthritis , lupus , scleroderma )
  • Having flat feet
  • Not stretching properly
  • Being overweight
  • Current use of quinolone antibiotics or corticosteroids, which can weaken tendons
  • Having weak or inflexible calf muscles
  • Not warming up properly before exercising, and not cooling down properly afterwards
  • Participating in certain activities, such as basketball, football, and rugby
  • Previously rupturing the Achilles tendon
  • Smoking
  • Using tendon-relaxing medications, which may lessen the pain and cause you to overuse the tendon
  • Wearing improper footwear

Tell your doctor if you have any of these risk factors.

Symptoms

If you have any of these symptom, do not assume it is due to Achilles tendon rupture. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:

  • Inability to push off from ball of foot
  • Inability to walk on affected leg
  • Popping or snapping noise when injury occurs
  • Sudden, extreme pain at back of heel
  • Swelling near your heel (severe with full rupture)
Diagnosis

Your doctor will ask about your symptoms and medical history. You will also have a physical exam. Tests may include:

  • MRI scan —a test that uses magnetic waves to make pictures of structures in the body; useful in viewing tendons and joints
  • Thompson test—a method to test the tendon by squeezing the calf muscle
  • Ultrasound—a test that uses sound waves to exam the tendon; may not be able to show the difference between a complete tear and a partial tear
  • X-ray —a test that uses radiation to take a picture of structures inside the body, especially bones
Treatment

Talk with your doctor about the best treatment plan for you. Upon injury, stop the activity. You may need to see a doctor right way. Treatment options include the following:

First Aid

For first aid after the injury, remember the acronym “RICE”:

  • Compress—Lightly wrap foot with compression bandage.
  • Elevate—To limit pain and swelling, elevate your foot.
  • Ice—Place a cold pack on the area.
  • Rest—Get off foot right away.
Medication

To relieve pain and reduce swelling, you may want to take:

  • Nonsteroidal anti-inflammatory medications (NSAIDS), such as:
    • Acetaminophen
    • Ibuprofen
Surgery

Surgery is the most common treatment for this condition. The doctor makes an incision in the lower leg. Then, she sews the tendon back together. A cast , splint, walking boot, or brace is worn for 6-8 weeks. One of the benefits of surgery is that it lowers the risk of re-rupturing the tendon. Surgery may also be a better option if you are very athletic.

Non-Surgical Care

The other option is to allow your tendon to heal without surgery. In this case, you also need to wear a cast, splint, walking boot, or brace for 6-8 weeks. A heel lift decreases force on the tendon. It may take longer to heal, though. You also may have different exercises to do. If you are less active or have a chronic illness that prevents surgery, this option may be better for you.

Rehabilitation

During rehabilitation, you will:

  • Begin with range-of-motion exercise . Often these will focus on the body as a whole.
  • Progress to weight-bearing exercises, using support devices (eg, walker or crutches).

Most people can return to normal activity in 4-6 months.

Prevention

To help reduce your chance of getting Achilles tendon rupture, take the following steps:

  • Change your routine. Switch between high-impact activities (eg, running ) and low-impact activities (eg, walking ).
  • Maintain a healthy weight .
  • Do exercises that strengthen your calf muscle.
  • Do warm-up exercises before an activity. Cool down with ice to the area.
  • Rest if you feel pain during an activity. Avoid activities that cause pain.
  • Stretch before exercising.
  • Wear proper footwear. Consider heel lifts.

These steps can also reduce your chance of repeat injury.

Last reviewed: September 2011 by Rosalyn Carson-DeWitt, MD.

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