Achilles Ruptures: Causes, Symptoms and Treatment

What’s in common with Kevin Durant, David Beckham, Brad Pitt, Dame Judy Dench, and George Clooney? The answer is they all tore their Achilles!

The Achilles tendon is the strongest tendon in the body. Also called the heel cord, it runs from the calf muscles towards the back of the heel bone, and facilitates walking and running movements by lifting the heel off the ground. During running and jumping movements, it can bear loads 6-12x the body weight (up to 2000 lbs!), yet it is one of the most common tendons to rupture. A complete rupture is a significant injury often resulting in lost time at work, and restricted participation in sports up to a year following the injury. The overwhelming majority of people recover well and are able to return to some level of physical activity, however calf weakness and other biomechanical changes can persist in the long term.

Causes of an Achilles Rupture?

Unfortunately there is no known cause. However, it is most likely related to a reduced load capacity of the ankle/foot complex as a result of previous lower body injury, or sudden changes in load (e.g.: playing tennis only 2-3x in a year). Typically it is an injury of middle aged men who are participating in recreational sports. Women are less likely to suffer an Achilles ruptures as they represent 15-20% of all cases. It often happens during a quick forced hyper-dorsiflexion movement (sudden extreme calf stretch), but it can occur during an odd jump off the curb, as well.

Signs and Symptoms of an Achilles Rupture?

Symptoms can significantly differ if it is a full rupture vs partial tear.
This is a video of an Achilles rupture.

Partial tear signs and symptoms

• sudden pain around the Achilles tendon
• potential swelling
• limited strength, range of motion and function

Full tear signs and symptoms

• audible pop
• sudden pain in lower calf area
• often described as getting kicked in the calf
• unable to walk and/or put weight on it
• increased dorsiflexion at rest in prone position
• in rare cases, people can walk on a ruptured achilles for days/weeks before getting medical attention (this walk is a severe limp without any meaningful ankle movement)

The video below demonstrates the typical signs of a full rupture.

Surgery or No Surgery for an Achilles Rupture?

There is a two-decade-old debate about surgery vs non surgery, however, 1 year after the injury, the difference in outcomes are negligible. There is a 7-10 day window of opportunity following a full rupture when it is best to get a surgery. It should be a joint decision between the patient and the surgeon looking at age, general health status, access to rehabilitation, previous injuries etc. It can be an overwhelming decision to make in a short time, however it typically does not influence functional outcomes in the long term.

How can Physiotherapy Help with Treatment of an Achilles Rupture?

• Physiotherapy has a crucial role in recovery
• An initial consultation within the first few weeks is recommended to optimize rehab and start non weight bearing exercises. A virtual consultation is a great option as quite often patients are non weight bearing at this stage and may have difficulty commuting to a clinic.
• In-person rehabilitation starts around the 8 week mark, depending on the surgeon/protocol used. Total rehabilitation time is between 6-12 months. Physiotherapy primarily focuses on restoration of calf strength and function. In addition, optimal joint mobility, proper muscle length, balance, proprioception and global strengthening also takes place.
• Having a physiotherapist who is experienced treating this condition is extremely important because they have the ability to advocate for the patient, as well as progress the load accordingly. Too little progression early on delays recovery and reduces functional outcomes, but too much can cause setbacks.
• In addition to load management; manual therapy, physical modalities, dry needling, and taping can also be used to aid recovery.

If you believe you have an Achilles rupture, please get immediate medical assistance and contact us when you are ready to start your rehabilitation.

References:

1. Lerch, Till D., et al. “Return to Sport and Patient Satisfaction at 5-Year Follow-up After Nonoperative Treatment for Acute Achilles Tendon Rupture.” Foot & ankle international 41.7 (2020): 784-792.
2. Ochen, Yassine, et al. “Operative treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review and meta-analysis.” bmj 364 (2019).
3. Silbernagel, Karin: Optimal Loading for Achilles Tendon Rupture and Tendinopathy. Physio Network Masterclass, 2020.
4. Willits, Kevin, et al. “Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation.” JBJS 92.17 (2010): 2767-2775.