Tendons join muscles to bone and are made up of a tough connective tissue. The Achilles tendon attaches the calf muscles (gastrocnemius and soleus) to the heel bone. It is important in storing and releasing energy and is involved in many activities such as walking, running and jumping.

Achilles tendon ruptures are the most common tendon rupture in the lower extremity. Most occur during recreational sports and athletic events although some can occur in non-athletes and sedentary individuals.

Illustration showing a ruptured achilles tendon

Achilles tendon ruptures occur when the tendon fails to respond appropriately to a sudden force placed upon it. Some activities in which they occur include running, jumping, and changing direction. Other causes include direct trauma to the tendon, chronic degeneration of the tendon, auto-immune or inflammatory conditions, broad-spectrum antibiotic and/or steroid use and poor biomechanics.

Signs that you have ruptured your Achilles tendon

You may experience any of the following during a specific event:

  • Sudden sharp pain in the back of the ankle
  • A feeling of being kicked in the back of the ankle
  • Popping or snapping sound
  • Sudden inability to walk
  • Swelling
  • Weakness with ankle movements.

Photo showing ankle with achilles tendon rupture

If you suspect that you have ruptured your Achilles tendon, the best thing to do is to see a specialist as soon as possible. The quickest way to do that is to go straight to the emergency department of your nearest hospital. Do not delay the process of the injury being seen to, as this can complicate the management and the ultimate outcome of the injury.

How are Achilles tendon ruptures managed?

  1. First, you will need to consult with a surgeon.
  2. The surgeon will then decide if you need to have surgery or not.
  3. Surgery involves re-approximation (connecting) of the torn ends of the tendon followed by a period of immobilisation of the ankle in a cast or brace.
  4. Conservative management involves a period of time in which the ankle is kept immobile (unmoving) in a cast or brace.

Physiotherapy management after Achilles tendon rupture repair

After surgical and conservative management of Achilles tendon ruptures you will require physiotherapy. A strict protocol or process is followed to ensure the best outcome. Initially, you will be mobilising (returning to movement) using crutches, usually non-weight bearing on the injured foot. Once your cast is removed you will be placed into a moon boot with wedges to elevate the heel. Those wedges will slowly be removed over time so that the foot gradually returns to a neutral position. During this time, it is important to avoid excessive stretching of the Achilles tendon.

Physiotherapy will include:

  • Education on the injury and management thereof.
  • Pain management.
  • Progressing your walking from non-weight bearing to partial- and then full-weight-bearing.
  • Exercises to improve range of motion and prevent stiffness of the ankle.
  • Exercises to strengthen the calf muscles and Achilles tendon.
  • Balance and proprioception exercises.
  • Extensive rehabilitation to ensure a return to sport.

Foot raiser exercise for achilles tendon rupture management

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