Achilles Tendon Rupture

Torn achilles

A total rupture of the Achilles tendon is a complete tear of the tendon and typically affects men over the age of 40. It is not always obvious if you have a completely torn Achilles tendon, but if you have, it is essential you seek medical attention as soon as possible.

Achilles tendon rupture symptoms

Symptoms or a torn Achilles tendon include:

  • A sudden sharp pain in the Achilles tendon at the back of your ankle.
  • The pain is often described as being struck physically on the back of your ankle by an object or implement.
  • You may hear a loud snapping noise or bang at the time of injury.
  • You may see or feel a gap of 4 to 5 cm in your tendon immediately after injury. However, this may be less obvious later as swelling increases.
  • You will have considerable loss of function and strength in the injured ankle.
  • You will most likely be limping, however, often patients are quite capable of walking or even playing on. This is because other muscles compensate.

Assessment tests

There are four key tests to help diagnose a complete rupture of the Achilles tendon:

Thompsons test for ahilles tendon rupture
Thompsons squeeze test for a torn achilles

1. With the patient lying face down with their feet hanging over the edge of a table or therapy couch, the foot of the injured side will hang directly down, compared to the non injured one would be slightly pointed (plantar flexed).

2. Is there a gap of approximately 3 to 6 cm in the Achilles tendon directly after injury? If there is too much swelling then this is not always obvious.

3. Plantar flexion strength is significantly reduced. For example, the patient will be unable to point their foot downwards against resistance or go up on top toes.

4. Thompson’s squeeze test will give a positive result. Thompson’s test is performed by squeezing the calf muscles at the belly of the muscle. If the foot does not move then complete rupture is indicated.


What is a complete rupture of the Achilles tendon?

Total rupture of the achilles tendon

A torn Achilles is simply a tear of the Achilles tendon. It can be a partial rupture or a total rupture. A total rupture is 10 times more common in men than in women.

The Achilles tendon connects the calf muscles at the back of the lower leg and inserts at the back of the heel or calcaneus bone. Huge forces are transmitted through the tendon when running and jumping. The tendon itself is surrounded by a thin sheath.

What causes a torn Achilles?

  • Typically it occurs 30 to 40 minutes into a period of exercise, rather than at the start of a session.
  • Nearly always it results from either a sudden explosive movement or when forcibly bending the foot upwards (known as dorsiflexing).
  • A rupture may (but not always) follow long term tendon pain which a patient may have put up with, or ignored for some time.

Many patients are able to continue to function following an Achilles rupture due to other lower leg muscles compensating, although the injured leg will be significantly weaker.

Treatment for a total rupture of the Achilles tendon

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If a total rupture of the Achilles tendon is suspected then apply cold therapy and compression and seek medical attention as soon as possible.

Do I need surgery?

If you are unlucky enough to suffer a complete rupture of your Achilles tendon then you have two choices:

  • Conservative treatment (without surgery)
  • Surgery to repair the torn tendon

Conservative treatment

The conservative route involves initial immobilization to allow the tendon to heal, followed by strengthening and improving flexibility.

Read more on Achilles tendon rupture rehabilitation.


Surgery

In most cases, achilles tendon surgery is required and the sooner this takes place the higher the chances of success.

If your injury is left longer than two days before being operated on then the chances of a successful outcome may decrease.

A full rehabilitation program is necessary following surgery with the patient being out of competition for between 6 and 12 months.

This article has been written with reference to the bibliography.