Achilles Tendon Ruptures
Background
The Achilles tendon connects the calf muscles to the heel bone. It provides the power to push off the ground when walking, running, and jumping.
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An Achilles tendon rupture occurs when the tendon tears, often during a sudden push-off, sprint, jump, or change in direction. Many people describe feeling as though someone kicked them in the back of the ankle. Although the injury is common in sports, it can also happen during everyday activity.
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Both surgical and nonsurgical treatment can be effective. The best choice depends on the tear, your health, activity goals, and how soon treatment begins.
Symptoms
An Achilles tendon rupture may cause:
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A sudden pop or snapping sensation behind the ankle
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The feeling of being struck in the back of the leg
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Pain and swelling near the heel
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Difficulty pushing off while walking
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Weakness when pointing the foot downward
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Inability to rise onto the toes of the injured leg
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Pain may lessen after the initial injury, even though the tendon is still torn. If you suspect a rupture, seek prompt evaluation and avoid continuing to play or exercise.
Diagnosis
Dr. Fliegel will ask how the injury occurred and examine the tendon for tenderness, a gap, and loss of function. He may perform a calf squeeze test to assess whether the tendon is intact.
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The diagnosis can often be made through the history and examination. Ultrasound or MRI may be used when the findings are unclear or when more information about the tear would help guide treatment.
Treament Options
Treatment aims to allow the tendon to heal while restoring strength and function. Dr. Fliegel will discuss both approaches, including their benefits, risks, and rehabilitation requirements.
Nonoperative Treatment
Nonsurgical care uses a boot or cast that holds the foot pointed downward, bringing the torn tendon ends closer together as they heal. Treatment then progresses through a structured rehabilitation program with guided weight bearing, motion, and strengthening.
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This can be a good option for many patients, but following the boot and rehabilitation instructions closely is essential. Dr. Fliegel will discuss how the risk of another rupture and the expected return of strength apply to your situation.
Operative Repair
Surgery brings the torn tendon ends back together. In selected cases, particularly when the tear is older, there is a large gap, or the tendon tissue is poor, the repair may require additional support. This can include a tendon transfer, graft, or other form of augmentation. These techniques are not needed for every rupture and are chosen based on the condition of the tendon.
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Surgery may be considered for patients with certain tear characteristics or high athletic demands. Dr. Fliegel will discuss the approach that best fits your injury, along with the rehabilitation process and risks, including wound problems, infection, and nerve irritation.
Return to Sport
Rehabilitation after an Achilles tendon rupture progresses gradually from walking and strengthening to running, jumping, and sport specific movements. Around 16 weeks after surgery, some athletes may begin controlled practice activities if their recovery allows. They can then progress through noncontact drills, contact drills, and eventually full competition.
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A return to preinjury activity may take 4.5 to 12 months or longer. Before full clearance, patients should have restored ankle motion, minimal swelling, strong calf function, and balance, hopping, and agility comparable to the uninjured side. The timing depends on healing, the demands of the sport, and how the patient performs during rehabilitation.