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Achilles Tendon Rupture – Causes, Symptoms & Treatment

An Achilles tendon rupture is a complete or partial tear of the Achilles tendon. It commonly occurs during sports and requires prompt medical attention.

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Things worth knowing about "Achilles Tendon Rupture"

An Achilles tendon rupture is a complete or partial tear of the Achilles tendon. It commonly occurs during sports and requires prompt medical attention.

What Is an Achilles Tendon Rupture?

An Achilles tendon rupture is a complete or partial tear of the Achilles tendon, the largest and strongest tendon in the human body. It connects the calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus). Despite its strength, the tendon can tear due to sudden overload or pre-existing degenerative changes. A distinction is made between a complete rupture (full tear) and an incomplete rupture (partial tear).

Causes

An Achilles tendon rupture is most commonly caused by a sudden, forceful stress on the tendon. Typical triggers include:

Abrupt acceleration or jumping movements during sports (e.g., football, basketball, tennis)
Unusual or intense physical activity after a period of inactivity
Pre-existing degenerative tendon changes (tendinopathy) that weaken the tissue
Direct trauma, such as a kick to the tendon
Use of certain medications (e.g., fluoroquinolone antibiotics or corticosteroids) that can weaken tendon tissue

Symptoms

The symptoms of an Achilles tendon rupture are typically sudden and severe:

Sudden, sharp pain in the calf or heel, often accompanied by a loud snap or pop
Swelling and bruising (hematoma) around the heel and lower leg
A palpable gap in the tendon (sometimes described as a dent)
Significantly reduced ability to walk; inability to stand on tiptoe
Positive Thompson test: squeezing the calf does not produce the normal downward movement of the foot

Diagnosis

Diagnosis is primarily clinical, based on physical examination and the patient's history. Imaging studies are used to confirm the diagnosis:

Ultrasound (sonography): A quick and cost-effective method to visualize the tendon tear
MRI (magnetic resonance imaging): Provides detailed images of the extent of the rupture and any associated injuries
Clinical tests, especially the Thompson test

Treatment

Conservative Treatment

Conservative management involves immobilizing the foot in a special boot or splint in a slightly pointed position (equinus position). This allows the torn tendon ends to heal naturally. This approach is often preferred for older or less active patients.

Surgical Treatment

Surgery involves suturing the torn tendon ends back together. It is generally preferred for younger, physically active patients, as it reduces the risk of re-rupture and often allows a faster return to athletic activity.

Rehabilitation

Regardless of the treatment chosen, intensive physiotherapy is essential. Rehabilitation includes:

Progressive strengthening of the calf muscles
Gait training and coordination exercises
Gradual return to sports activities (typically after 6 to 12 months)

Prognosis

With prompt and consistent treatment, the prognosis is generally favorable. However, there is an increased risk of re-rupture, making thorough rehabilitation and long-term strengthening of the calf muscles critically important.

References

Deutsche Gesellschaft fur Orthopädie und Unfallchirurgie (DGOU): Guideline for the Treatment of Achilles Tendon Rupture, 2022.
Maffulli N, Oliva F, Maffulli GD et al. - Surgical and conservative Achilles tendon rupture treatment: a systematic review. - British Medical Bulletin, 2020.
van Dijk CN, van Sterkenburg MN, Wiegerinck JI et al. - Terminology for Achilles tendon related disorders. - Knee Surgery, Sports Traumatology, Arthroscopy, 2011.

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