Achilles Tendon Rupture

Achilles Tendon Rupture

Article by John Miller

Achilles Tendon Rupture

What is an Achilles Tendon Rupture?

Achilles tendon rupture

What Causes an Achilles Tendon Rupture?

When your Achilles tendon snaps or pops, it is known as Achilles tendon rupture. Often an Achilles tendon rupture can occur spontaneously without any prodromal symptoms. Unfortunately, the first “pop” or “snap” that you experience your Achilles tendon rupture.

Achilles tendon rupture most commonly occurs in the middle-aged male athlete (the weekend warrior who is engaging in a basketball pickup game, for example). Injury often occurs during recreational sports that require bursts of jumping, pivoting, and running. Most often, these are tennis, racquetball, squash, basketball, soccer, softball and badminton.

Achilles rupture can happen in these situations:

  • You make a forceful push-off with your foot while the powerful thigh muscles straighten your knee. One example might be starting a foot race or jumping.
  • You suddenly trip or stumble, and your foot is thrust in front to break a fall, forcefully overstretching the tendon.
  • You fall from a significant height.

The most significant risk factor for Achilles tendon rupture is tendon cell death resulting from poorly managed tendinopathy.

Higher Risk of Achilles Tendonitis History

It does appear that any previous history of Achilles tendinopathy results in a degenerative tendon, which can grow weak and thin with age and lack of use. Then it becomes prone to injury or rupture. Certain illnesses (such as arthritis and diabetes) and medications (such as corticosteroids and some antibiotics) can also increase Achilles tendon rupture’s risk.

Achilles Tendon Diagnosis

Achilles tendon ruptures misdiagnosis is a staggering 20%-30%. Yet, they shouldn’t be if your healthcare practitioner is methodical and thorough in their assessment. Thompson (calf squeeze) test is 96% sensitive and 93% sensitive. Unfortunately, some health practitioners fail to perform this simple clinical test. An ultrasound examination or an MRI can confirm an Achilles tendon rupture. A palpable “gap” in the Achilles tendon is another positive sign of at least partial rupture.

Please consult your trusted physiotherapist or a sports doctor for a thorough Achilles assessment.

Ruptured Achilles Tendon Treatment

Treatment of a ruptured Achilles tendon is usually conservative (non-operative) in a Controlled Motion Ankle (CAM) Boot, or it may require surgery. Your decision should involve a conversation with your ankle surgeon.  The current consensus based on research is to treat them conservatively since the functional outcome and chance of re-rupture is similar (7% to 15%) using both approaches. Surgical intervention has a higher risk of infection.

Achilles tendon surgery is more likely if your Achilles has re-ruptured or a delay of two weeks between the rupture and the diagnosis and commencement of conservative bracing and treatment.

Post-Achilles Repair Physiotherapy

Most surgeons will recommend that you commence physiotherapy about one-week post-op. It is vital to not over-stress your Achilles tendon repair. We recommend the professional guidance of a physiotherapist experienced in Achilles tendon rupture rehabilitation for your best outcome.

Ruptured Achilles Tendon Prognosis

You will typically be in your CAM brace for between 6 to 12 weeks. If everything goes perfectly during your rehabilitation, it takes at least 12 weeks before considering your graduated return to sport program. This timing is, of course, at the discretion of your Achilles surgeon. However, some Achilles tendon repairs can take six to 12 months to rehabilitate successfully and return to sport if there are complications.

Seek Professional Advice

The best advice is to seek early advice from your physiotherapist, doctor or orthopaedic surgeon. Delay does result in a poorer prognosis.

If you are lucky, you may avoid surgery but require a walking boot, or similar, with a graduated rehabilitation program to strengthen your injured tendon and prevent a further injury.

Acute Injury Signs

Acute Injury Management.

Here are some warning signs that you have an injury. While some injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop.

For detailed information on specific injuries, check out the injury by body part section.

Don't Ignore these Injury Warning Signs

Joint Pain

Joint pain, particularly in the knee, ankle, elbow, and wrist joints, should never be ignored. Because these joints are not covered by muscle, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a professional diagnosis.

Tenderness

If you can elicit pain at a specific point in a bone, muscle, or joint, you may have a significant injury by pressing your finger into it. If the same spot on the other side of the body does not produce the same pain, you should probably see your health professional.  

Swelling

Nearly all sports or musculoskeletal injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may feel as though something is swollen or "full" even though it looks normal. Swelling usually goes along with pain, redness and heat.

Reduced Range of Motion

If the swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion. Compare one side of the body with the other to identify major differences. If there are any, you probably have an injury that needs attention.

Weakness

Compare sides for weakness by performing the same task. One way to tell is to lift the same weight with the right and left sides and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another suggestion of an injury that requires attention.

Immediate Injury Treatment: Step-by-Step Guidelines

  • Stop the activity immediately.
  • Wrap the injured part in a compression bandage.
  • Apply ice to the injured part (use a bag of crushed ice or a bag of frozen vegetables).
  • Elevate the injured part to reduce swelling.
  • Consult your health practitioner for a proper diagnosis of any serious injury.
  • Rehabilitate your injury under professional guidance.
  • Seek a second opinion if you are not improving.