The Achilles tendon is the large tendon just above your heel that you can feel like a cord when you move your foot up and down. It’s the largest and strongest tendon in the body. If the tendon tears, or snaps then this is called an Achilles tendon rupture. A rupture can be partial or total, depending on whether any of the tendon is still attached.
Achilles tendon rupture can occur at any age, but is more common in men between the ages of 30 and 50, and is more common in elite athletes although it can happen in anyone. The injury commonly happens during exercise without warning – especially if your foot is suddenly pushed hard off the ground such as when you’re jumping or sprinting - and feels like being stabbed or kicked in the calf. You might hear a loud pop or snap at the time of injury, swelling and bruising between the heel and the calf, and difficulty moving the foot normally – it will be difficult to stand on your tip toes.
In the first instance, simple first aid is the best way to start. Rest and elevate the injured leg, ice the area (be sure not to place ice directly on skin, use something like a tea towel to protect the skin) and compress the injured area with an elastic bandage.
An Achilles tendon rupture is painful, and taking over-the-counter painkillers and anti-inflammatories is a good next step.
If you suspect that you have ruptured your Achilles tendon, always seek urgent medical attention from your local emergency department. The condition is usually managed by hospital teams, and if you see your doctor they will refer you to the hospital team. The sooner this condition is treated the better the chance of a full recovery.
Your doctor will ask you about your symptoms, your medical history, and any relevant family medical history. They will then examine your calf and Achilles, performing different tests to confirm the possible rupture. Your doctor will commonly arrange some imaging such as an X-ray to exclude any bony injury, or an ultrasound scan to assess the Achilles tendon in more detail. If these can be done as an outpatient, you may be placed in a supportive boot or cast whilst waiting for the follow-up appointment where the results are discussed.
If a rupture is confirmed, the two options for treatments are surgery or functional bracing. The most common management is functional bracing, where the foot is placed in a boot for a number of weeks with small adjustments to allow the tendon to heal over time. Another option is to wear a cast for several weeks from the knee down, with your foot put in a fully downwards position. This means you can’t put weight on your leg and will need to use crutches while in the cast. You’re more likely to need surgery if there’s been a delay in treating the tendon, if it keeps happening, or if you’re young and very active.
Your recovery time depends on whether you have had surgery or not. Whatever type of treatment you have, you can usually expect to be able to be back doing normal activities within four to six months although it can take longer to get back to high-impact sports such as football or squash.
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