What is an Achilles tendon rupture?
The Achilles tendon, also known as the calcaneal tendon, is the largest in the body and serves an important role in walking, running, and jumping. Connecting the calf muscle to the heel bone, the thick fibrous band of tissue withstands plenty of stresses during athletic activities. But when stressed, it can also stretch and rupture or tear, partially or fully. The severity of any tear will determine the Achilles tendon injury symptoms, surgical options, and recovery timetables.
A full rupture of the Achilles tendon occurs when the body's largest tendon is stretched too far, typically during running or jumping, and the fibrous band of tissue entirely tears. The Achilles tendon connects the back of the calf muscle to the heel bone. It plays a critical part in lower leg movement and facilitates walking, running, and jumping by allowing the foot to move and the toes to point downward. When it tears, it can cause pain and stability issues, especially if the athlete attempts to perform athletic movements. Men in their 30s and 40s are at the highest risk of an Achilles tear, mainly due to sports injuries caused by not regularly training and then performing bursts of high-intensity activities.
Both surgical and nonsurgical treatment options are available for treating an Achilles injury.
What are the grades of an Achilles tendon tear?
- Grade 1: A mild injury that brings minimal torn tendon fibers, known as a partially torn Achilles
- Grade 2: When less than half the Achilles tendon fibers tear
- Grade 3: Considered a full rupture when the majority or all the fibers tear
What are Achilles tendon rupture symptoms?
An Achilles tendon rupture is a sudden injury that happens during movement. Athletes report feeling or hearing a popping sound and the sensation of being struck in the lower calf. After the initial injury to the Achilles tendon, common symptoms include:
- Pain around the Achilles tendon area
- Swelling and thickening of the tendon
- Instability and difficulty walking, especially on an incline or decline
- Tenderness at the point of injury to the Achilles tendon
- Increased pain and stiffness with use
What causes an Achilles tendon rupture?
An Achilles tendon rupture can occur in any athletic activity where the athlete is running or jumping. Intense movements can stress the tendon and overstretch the tendon fibers, causing a tear. Common causes of an Achilles tendon rupture during athletic activity include:
- A sudden stop or start that places increased stress on the Achilles tendon
- A traumatic twist or pivot can stretch an Achilles tendon to the point of tearing
The most common sports with Achilles tendon tears include soccer, basketball, tennis, squash, pickleball and football. The rupture usually occurs about two inches from where it connects to the heel bone, potentially because less blood reaches this tendon area.
Understanding risk factors of an Achilles tendon rupture
The risk factors for rupturing an Achilles tendon range from activity to the athlete's age and gender to physical condition.
- Age: Achilles tendon ruptures occur most commonly in those aged in their 30s and 40s
- Gender: Men suffer from an Achilles tendon rupture five times more frequently than women
- Physical condition: Infrequent sports participation increases the risk because the athlete isn't in optimal physical condition and undergoes brief moments of high-intense movements
- Weight: Being overweight or obese places additional stress on the Achilles tendon
- Medications: Tendons can weaken with some medications, both specific antibiotics, and steroid injections
How to diagnose an Achilles tendon rupture
A doctor's Achilles tendon tear diagnosis can include a physical examination and imaging technology. A physical exam to diagnose an Achilles tendon rupture often includes:
- Questions about the injury and extent of pain in the lower leg
- Movement testing to evaluate pain, range of motion, and stability
- Special tests to measure the automatic flex of the foot
Through a physical exam, your doctor will determine the injury's severity and any additional damage to surrounding muscles and bones. Imaging technology can be used to evaluate the Achilles tendon injury further. An X-ray can show the health of bones, including bone spurs, and may reveal if the tendon has hardened and calcified. A magnetic resonance imaging (MRI) scan is common for an Achilles injury to show the extent of the tendon damage.
Call or request an appointment with a Mass General Brigham sports medicine specialist to learn more about diagnosing and treating an Achilles tendon injury.
How is an Achilles tendon rupture treated?
Treatment can range from rest and immobilization to surgery, depending on factors including patient activity level, overall health, and patient preference.
A non-surgical approach allows the Achilles tendon to heal naturally. Typically, this requires a period of rest and immobilization of the foot and ankle. Following immobilization, athletes will need to strengthen the muscles around the Achilles tendon and engage in physical therapy and low-impact exercise as rehabilitation.
Surgery is a common treatment path for Achilles tendon rupture. A surgeon stitches the torn tendon fibers together during the procedure and immobilizes the foot and ankle during rehabilitation. If the rupture is extreme, using tissue from elsewhere in the body may be necessary.
How long does a ruptured Achilles take to heal?
An Achilles tendon rupture typically takes four to six months to heal fully. Both nonsurgical and surgical treatment options require exercise to strengthen muscles around the tendon. Physical therapy can assist with the rehabilitation process of the tendon and mobility.
Athletes will start rehabilitating quickly following a period of immobilization. Improving strength and mobility through specified exercises improves the prognosis for Achilles tendon recovery. With pain and stability still an issue early in recovery, athletes often need to modify their exercise routines. Swimming and other low-impact exercises can help with conditioning while gradually adding more weight-bearing activities to the lower leg as athletes move toward a full recovery from a ruptured Achilles tendon.
An Achilles tendon rupture typically takes four to six months to heal fully but return to sport can take longer than a year sometimes. Both nonsurgical and surgical treatment options require exercise to strengthen muscles around the tendon. Physical therapy can assist with the rehabilitation process of the tendon and mobility.
Athletes will start rehabilitating quickly following a period of immobilization. Improving strength and mobility through specified exercises improves the prognosis for Achilles tendon recovery. With pain and stability still an issue early in recovery, athletes often need to modify their exercise routines. Swimming and other low-impact exercises can help with conditioning while gradually adding more weight-bearing activities to the lower leg as athletes move toward a full recovery from a ruptured Achilles tendon.
How do you prevent an Achilles tendon tear?
Sudden injuries that occur during athletic activities can't be entirely prevented. Reducing risk factors can help lower the chance of rupturing your Achilles tendon. Key strategies for ensuring your Achilles tendon remains in the best possible condition include:
- Maintaining a consistent intensity in activities. A sudden jump from no activity to high intensity can overstress the tendon
- Strengthening and stretching calf muscles to ensure the muscle can help the Achilles tendon handle the extra stress
- Properly warming up before activities and increasing activity gradually
- Exercising on even surfaces and wearing proper footwear
- Reducing stress on the Achilles tendon by rotating athletic activities and limiting high-impact activities
FAQs
Yes, commonly, you can still walk with a torn Achilles tendon, although it may cause pain. It isn't a good idea to continue using a torn Achilles tendon.
If proper treatment protocols are followed, the typical recovery time for an Achilles tendon rupture can take anywhere from four to six months.
A rupture typically refers to a grade 3 tear, considered the most severe of the three tear grades, when most of the tendon is torn.
A torn Achilles tendon needs to be treated to heal properly. Left untreated, it may not fully heal or heal improperly, resulting in loss of strength and mobility.
Achilles tendon surgery is usually either done via open surgery or percutaneously, using several small incisions to reach the tendon and reattach it. Recovery can take four to six months.
