The Achilles tendon is one of the strongest tendons in the human body. If it ruptures, you can usually hear a clear snapping sound. Achilles tendon ruptures usually affect amateur athletes between the ages of 30 and 60. Fully torn tendons generally require surgical reconstruction.

Achillessehnenruptur

Overview of the Achilles tendon

The Achilles tendon, named after the mythical Greek hero Achilles, is one of the strongest tendons in the human body and connects the calf muscles to the heel bone. Its main function is to enable plantar flexion of the foot, i.e. moving your foot downwards away from the body, which is essential for movements such as walking, running and jumping. The Achilles tendon plays a crucial role in the mobility and stability of the foot, both in everyday life and during physical exercise.

Risk factors & causes

The main risk factors that can increase your chances of suffering an Achilles tendon rupture are sudden, forceful impacts, long-term overuse of the tendon, muscle weakness or imbalance in the surrounding muscles, pre-existing tendon disorders and age:

Sudden impact

Abrupt, forceful movements or sudden impact on the tendon, which can occur when setting off quickly, sprinting or stopping abruptly, can lead to an Achilles tendon rupture.

Long-term overuse

Long-term overloading of the Achilles tendon can lead to micro-tears in the tendon, which can eventually lead to a complete tear.

Muscle weakness or imbalance

Weakness or imbalance in the surrounding muscles, particularly the calf muscles, can put additional pressure on the Achilles tendon and increase the risk of rupture.

Age

People between the ages of 30 and 60 have an increased risk of an Achilles tendon rupture, as tendon elasticity decreases the older you get and wear and tear can occur.

Pre-existing tendon disorders

Pre-existing tendon disorders such as tendinopathy (tendonitis) or tendon degeneration can weaken the Achilles tendon and increase the risk of rupture.

Symptoms

The symptoms of an Achilles tendon rupture are usually unmistakable and can manifest in a number of ways, including: 

Popping sound

Some patients hear an audible popping or tearing sound at the moment the Achilles tendon ruptures.

Sharp pain

An acute Achilles tendon rupture often manifests itself with immediate, usually severe pain in the heel or lower leg.

Swelling and tenderness

If the Achilles tendon has ruptured, the surrounding area can swell and feel sensitive to touch.

Denting

If the Achilles tendon is torn, there may be a dent above the heel and possibly bruising.

Restricted mobility

Mobility, especially upward or downward movement of the foot, can be severely restricted. With an Achilles tendon rupture, you won’t be able to push off on the affected foot or walk on your toes.

Tendon rupture infographic

Diagnosis

Achilles tendon ruptures can be diagnosed by an orthopaedics specialist, usually based on what happened when the injury occurred, the typical symptoms and a physical examination. Imaging techniques can also be used to precisely determine the extent of the tendon rupture:

Ultrasound examination (ultrasonography)

The doctor can use an ultrasound to see the structure of the Achilles tendon and determine the exact location of the rupture. This method is particularly useful for assessing the size of the tear and the extent of the surrounding tissue damage.

X-ray images

Although an Achilles tendon rupture cannot be seen on X-rays, they can be used to detect any avulsion fractures (when a bone fragment attached to the tendon pulls away from the main part of bone).

Magnetic resonance imaging (MRI)

If the tendon is not completely ruptured, just partially torn, an MRI can help determine more precisely the severity of the injury and the extent of the damage.

Treatment

Treatment of an Achilles tendon rupture or partial tear depends on various factors, including the severity of the injury and the patient’s level of activity. The decision on the appropriate treatment should therefore be made in consultation with a qualified doctor or orthopaedic specialist. Treatment falls into two categories, surgical and conservative (non-surgical):

Conservative treatment

Conservative treatment can be considered for a partial tear of the Achilles tendon or a minor injury. This includes the ‘R.I.C.E’ method: rest, ice, compression and elevation to reduce swelling and inflammation. The affected foot can be immobilised with an orthopaedic splint or a special boot to relieve strain on the affected area and promote healing.

Surgical treatment

In the case of a complete Achilles tendon rupture or a severe partial tear, tendon surgery may be necessary. Surgical treatment of an Achilles tendon rupture involves suturing the two ends of the tendon together. This procedure can be performed using an open or semi-open surgical method.

Follow-up care, rehabilitation and recovery

Follow-up care and rehabilitation following an Achilles tendon rupture are crucial for the patient to be able to recover properly. This includes physiotherapy to restore mobility and strength, gradual increases in exercise, monitoring and adjustment of the treatment plan as well as long-term care and prevention.

After around two months following an Achilles tendon rupture, the foot is usually able to bear weight again, meaning careful walking exercises can be slowly introduced. Patients are recommended to start with short distances and gradually increase the intensity. Lighter physical activities should only be resumed three to six months after the injury.

Prevention

Even though the Achilles tendon can rupture without warning, there are a number of preventative measures that can help to minimise the risk of this kind of injury:

  • Warming up and stretching before physical activities
  • Gradually increasing intensity
  • Strengthening the surrounding muscles, especially the calf muscles
  • Regular rest and regeneration
  • Appropriate footwear

 

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