Achilles Tendon Rupture

This page describes the condition of Achilles Tendon Rupture and the approach to this condition adopted by Mr Bowyer, at the Wessex Nuffield Hospital. Other surgeons may use variations on the techniques, for instance with regard to post-operative management. It is important that you understand what your own surgeon intends to do, and how you will be treated after the procedure.

Achilles tendon rupture is a complete tear of the Achilles tendon. This tendon is the tendon attachment of the calf muscles, to the heel bone. There is loss of continuity between the calf muscles and the heel bone and thus loss of function of the calf muscles. The function of the calf muscles is to forcefully push the front of the foot down (such as when standing on toes or when pushing off with walking, running, or jumping).

• “Pop” or rip at the back of the heel at the time of injury
• Pain and weakness when moving the foot (especially when pushing down with the front of the foot)
• Tenderness, swelling, warmth, and redness around the Achilles tendon
• Bruising at the Achilles tendon and heel after 48 hours
• Often a gap can be felt in the tendon where the injury occurred

• Sudden episode of stressful overuse, such as with jumping, hurdling, or starting a sprint, especially in sports such as tennis, squash and badminton
• Direct blow or injury to the lower leg, foot, or ankle

• Sports that require sudden, explosive muscle contraction, such as those involving jumping and quick starts, and running or contact sports
• Poor physical conditioning (strength and flexibility)
• Previous injury or condition such as Achilles Tendinitis
• Cortisone injection into the Achilles tendon
• Medical problems, such as decreased circulation due to any cardiovascular medical problem or obesity

• Appropriately warm up and stretch before practice or competition.
• Allow time for adequate rest and recovery between practices and competition
• Maintain appropriate conditioning
  • Ankle and leg flexibility
  • Muscle strength and endurance
  • Cardiovascular fitness

• This injury is usually curable with appropriate treatment.
• A return to sports is usually possible after 6 to 9 months

• Weakness of the calf muscles can occur, especially if the rupture goes untreated
• Re-rupture of the tendon is possible even after treatment
• Prolonged disability can occur
• Risks of surgery include infection, bleeding, injury to nerves, and impaired wound healing

General Treatment Considerations

Definitive treatment options include surgical and nonsurgical intervention. The return to sports is usually about the same with either treatment course but can occur sooner with surgery, and probably has a lower risk of re-rupture if the tendon is surgically repaired.

• Nonsurgical treatment usually involves a plaster cast or special boot for approximately 6 weeks, followed by a walking boot for an additional 4 to 12 weeks. The advantages of nonoperative treatment include a lack of the risks involved with anesthesia or surgery (such as infection, bleeding, or injury to nerves). The disadvantages include usually longer immobilization in a cast, resulting in initially stiffer ankle joints and weaker calf muscles. There is a slightly higher risk of rerupture of the tendon if treated non- surgically.
• Surgical treatment usually involves sewing the ends of the tendon back together, followed by immobilization in a special boot. The advantages of surgery include usually not needing to immobilize for as long, lower risk of rerupture of the tendon, and slightly stronger calf muscles. The disadvantages include the risks of anesthesia and surgery, specifically impaired wound healing and the possibility of injury to a nerve that provides sensation to the side of the foot.

Following either surgical or non-surgical treatment you will be referred to a physiotherapist who will help you regain your range of movement, strength and later a return to sporting activity. They will liaise with the surgeon and will give you specific exercises to achieve this return to activity, whilst limiting the chance of re-rupture.