What is Achilles Tendon Rupture?
Achilles tendon rupture (tear) refers to a complete tear or detachment of the Achilles tendon, which connects the calf muscles to the heel. Typically, a rupture is caused by a sudden, specific (acute) injury.
- The Achilles tendon is the most commonly ruptured tendon in the body[1]
- Men are five times more likely than women to experience Achilles tendon rupture[1]
- Achilles tendon rupture most commonly occurs in individuals between the ages of 30 and 60[2]
Expert Insights
Understanding Achilles Tendon Injuries - J. Carr Vineyard, MD
Anatomy
Tendons connect muscles to other bones. The Achilles tendon is the largest and strongest tendon in the body. It runs along the back of the lower leg, connecting the gastrocnemius and soleus muscles (calf muscles, also known as the triceps surae) to the calcaneus bone (heel bone) of the foot. The Achilles tendon is involved in plantar flexion of the foot (flexing the foot downward, away from the body) and is important for many activities such as walking, running, and jumping.
What is the Cause of Achilles Tendon Rupture?
Achilles tendon rupture is typically caused by an acute injury during a high-intensity activity such as running or jumping. Sudden strain on the tendon causes the tendon fibers to tear completely or to detach from the calcaneus, interfering with normal tendon function.
Elderly individuals are at risk for spontaneous rupture as the Achilles tendon weakens with age.
Other conditions affecting the Achilles tendon include:
- Achilles tendonitis: inflammation of the Achilles tendon, most commonly caused by overuse
- Achilles tendinosis: chronic degeneration and thickening of the Achilles tendon that is not associated with inflammation
- Achilles paratenonitis: inflammation of the covering (paratenon) of the Achilles tendon
What are Risk Factors for Achilles Tendon Rupture?
Factors that can lead to Achilles tendonitis include:
- A sudden increase in activity duration or intensity, especially activity involving jumping
- Engaging in high-intensity sports such as football, baseball, basketball, tennis, and racquetball
- Falling from a height
- Stepping into a hole
- Pre-existing Achilles tendonitis or tendinosis
- Age (the Achilles tendon weakens with age, making it more susceptible to injury)
- Male sex (men are 5 times more likely than women to experience Achilles tendon rupture[1])
- Steroid injections in or around the ankle joint
- Use of fluoroquinolone antibiotics such as ciprofloxacin and levofloxacin
- Diabetes
- Chronic kidney disease
What are the Symptoms of Achilles Tendon Rupture?
The symptoms of Achilles Tendonitis commonly include:
- Sudden pain and swelling along the tendon
- A popping sound at the time of injury
- The feeling of being hit in the calf at the time of injury
- Difficulty or inability to plantar flex the foot (bend the foot downward, away from the body) or to stand on the toes of the affected foot
How is Achilles Tendon Rupture Treated?
Treatment for Achilles tendon rupture is dependent upon the severity of the tear, as well as upon individual considerations such as activity level and age. There is controversy over the effectiveness of the treatment of Achilles tendon rupture with surgical versus nonsurgical measures. Nonsurgical treatment is associated with significantly lower risks of infection and nerve damage as compared to surgical treatment. However, nonsurgical treatment is associated with a 6.2% higher rate of re-rupture of the tendon as compared to surgical treatment[3].
Nonsurgical treatment:
Older and less active individuals are more likely to treat Achilles tendon ruptures through nonsurgical measures such as:
- Rest and the use of crutches to keep weight off of the affected foot
- Ice and use of anti-inflammatory medication to reduce pain and inflammation
- Immobilization of the ankle with the use of a cast or walking boot
Typically, it is recommended that crutches are used to keep weight off of the affected foot for at least 4 weeks, and that the affected foot should be immobilized with a cast or boot for 8 to 12 weeks. Most individuals recover from a ruptured Achilles tendon through nonsurgical treatment in approximately 6 to 9 months.
Surgical treatment:
Younger and more active individuals are more likely to benefit from surgery to repair an Achilles tendon rupture.
The surgical procedure typically involves removing damaged portions of the tendon and any bone spurs, suturing the torn tendon together, and reinforcing the tendon with graft material if necessary.
Following surgery, it is typically recommended that crutches are used to keep weight off of the affected foot for 2 to 3 weeks, and that the affected foot should be immobilized with a cast or boot for 6 to 8 weeks. Most individuals recover from surgical repair of a ruptured Achilles tendon in approximately 4 to 6 months.
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