Achilles tendon rupture

The Achilles tendon tear is an injury on the back of the leg below the calf.
She often meets people who are active in sports.

The Achilles tendon is a strong fiber cord that connects the calf muscles to the heel bone.

If the Achilles tendon is overstretched, it can rupture. A distinction is made between a partial and a complete rupture.

The tendon ruptures with a whip-cracking sound, immediately followed by severe pain at the back of the ankle and calf, a normal occurrence and walking is usually difficult or impossible.
The best treatment option for a rupture of the Achilles tendon is usually surgery.
However, in many patients, conservative (non-surgical) treatment is just as successful.


What causes Achilles tendon ruptures?

An injury to the Achilles tendon can have the following causes:

  • Overload.
  • Too fast increase in athletic performance levels.
  • Lack of warm-up before training or competition.
  • Regular wearing of high heels; if there are no heels, the tendon is overused.
  • Shortened calf muscles or tendons.
  • Foot deformities: An Achilles tendon injury can be caused by flat feet or overpronation, i.e. a lateral tilting of the foot in the ankle joint.
  • It may be a degenerative rupture as a result of untreated Achilles tendonitis.
  • The Achilles tendon tear may have been caused by taking certain medications, including certain antibiotics, such as levofloxacin.

One step causes the flattening of the arch of the foot and the tension of muscles and tendons.

An Achilles tendon rupture occurs mainly in the following sports:

  • Run
  • Gymnastics
  • Dance
  • Soccer
  • Baseball
  • Basketball
  • Tennis
  • Volleyball

The Achilles tendon is more likely to rupture at the sudden onset of a movement. For example, the Achilles tendon of a sprinter is more likely to rupture at the beginning of a competition. The abrupt tension of the muscle can overload the tendon. Men over 30 are particularly at risk of suffering an Achilles tendon rupture.

Signs and symptoms of an Achilles tendon rupture

As preventive measures, stretching exercises and a thorough warm-up training before physical activity are recommended.

There may be sudden and severe pain at the back of the ankle or calf. They are often described as “as if someone had thrown a stone at the ankle”.
The crack produces a whip-cracking sound.
A few centimeters above the heel bone, a depression or hollow in the tendon may be noticeable and visible.

Symptoms of Achilles tendon rupture
The symptoms of a complete rupture of the Achilles tendon are sudden, acute pain in the tendon, such as a blow from behind. They are accompanied by a clearly audible whip-like sound.
Initially, stiffness, swelling and pain occur, later a bruise becomes noticeable, the calf becomes weak or completely unusable.
The pain may subside quickly and the smaller tendons may maintain the ability to stretch the toes. Without an Achilles tendon, lowering the tip of the foot (plantar flexion) is practically impossible.
Walking on tiptoe is not possible.
A complete crack is more common than a partial tear.


The athlete has difficulty walking, the tiptoe stand is impossible. At the site of the tendon rupture, a gap is visible and very likely there is a strong swelling.
A positive Thompson test confirms the diagnosis.
The patient lies on his stomach and the calf muscles are compressed from both sides.
If the foot does not move, a complete Achilles tendon rupture is to be feared.
This test isolates the connection between the calf muscle and tendon and excludes other tendons that could cause weak movement.


The doctor can make the diagnosis based on a thorough physical examination. An X-ray is usually not taken because it only shows the bones.

Attention: A rupture of the Achilles tendon is often confused with a minor tendon injury.
The examiner may be deceived by the swelling and weak extensibility of the toes.

An uncertain diagnosis can be confirmed by an ultrasound examination or magnetic resonance imaging.
Depending on the degree of injury, these examinations can also help to determine the best form of therapy.

What to do? Treatment and medication for Achilles tendon rupture

The optimal type of treatment depends on the age, the athletic requirements of the patient and the severity of the tear. As a rule, younger and physically active individuals opt for surgery to repair a complete Achilles tendon rupture, older people tend to use a conservative method of treatment.
Recent studies have shown similar efficacy of surgical and non-surgical treatment.

Conservative therapy usually involves the use of an orthosis or heel-raised shoes to raise the heel.
In this way, the torn tendon ends are brought closer to each other and can heal.
This treatment can be very effective and avoids potential surgical risks, such as infections. Nevertheless, with conservative therapy, there may be an increased risk of renewed cracks and recovery may take a longer period of time.
At the next tendon rupture, surgical correction can become more difficult.

Even with severe weakening, minor Achilles tendon injuries must heal on their own.
You just have to give the body enough time to relieve the pain.

Healing can be accelerated by the following measures:

  • Protection of the leg.
  • The injured ankle joint should be loaded as little as possible.
  • Crutches may be required.
  • Cool with ice compresses. To relieve pain and swelling, the ankle can be immersed in cold water for 20 minutes every three to four hours for the first two days.
  • Compression. An elastic bandage around the lower leg and ankle supports the swelling.

High storage. Place the leg on a cushion while sitting or lying down.
Taking painkillers or anti-inflammatories. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help relieve pain and swelling.

However, these medications have potential side effects, such as an increased risk of bleeding and ulceration.
They should be taken after meals and only from time to time, unless they are prescribed by the doctor.
Use a heel raiser. The doctor may recommend a heel elevation or shoe insert during the healing process.

This aid protects the Achilles tendon from further overvoltage.
According to the recommendation of the physiotherapist, stretching and strengthening exercises should be performed.
These therapeutic measures are usually sufficient. In severe cases, a rigid splint or plaster cast must be worn for 6 to 10 weeks, or even surgery to reconstruct the tendon or remove excess tissue.

Surgical intervention for Achilles tendon rupture

The Achilles tendon can be repaired as part of an operation, this is referred to as an Achilles tendon reconstruction.

During the operation, the ankle is incised at the back.
Normally, the cut is made laterally of the side halving midline, so that the shoes do not rub at the scar site.
The torn tendon ends are visited and fixed seams are applied on both sides.
These sutures are firmly connected to each other to reconstruct the Achilles tendon.
The procedure is performed under local anesthesia and is not painful; however, if the effect of anesthesia wears off, pain may occur when moving.

The complications that occur most frequently and cause the most concern after Achilles tendon reconstruction are wound healing disorders.
The skin above the Achilles tendon sometimes does not heal properly. Therefore, careful care of the surgical wound is of utmost importance.
Other potential problems include infection, stiffness of the ankle and a renewed rupture of the Achilles tendon (recurrence).

Prognosis for Achilles tendon rupture

Most people can restore their normal ability to exercise with conservative or surgical therapy.
Most studies certify that surgical treatment has a better result.
Athletes may be able to return to their activity more quickly and experience fewer new injuries.
With physiotherapy, healing times can be shortened.
As a rule, after the crack site has healed, a small crack remains.

mpchen in the scar region.
Atrophy (muscle wasting) of the calf muscles is a common complication.
The foot can be loaded with a heel rest about 6 weeks after the tear.

After about 4 to 6 months, running training can be resumed. With a lot of motivation and physiotherapy, the healing process can be accelerated in competitive athletes who are already running again 3 months after the injury.


0 – 3rd week: Adjustable orthosis, it keeps the foot at 30° in plantar flexion (pointed foot position).
No strain up to the 3rd week, no toe gait. Control of pain and edema (cold treatment, medication, massage and laser therapy). Movement of the toes, gentle movements of the foot within the orthosis, elevation of the stretched leg, bending and stretching of the knee joint.
In order to maintain physical condition, it is recommended to ride on the ergometer, kicking the heel, training with weights and swimming.

3rd – 8th week: The load on the leg is gradually increased and gait training begins (depending on the tolerability).
After 6 weeks, the leg can be fully loaded.
Walking with the orthosis, increasing dorsiflexion by 5° every week until plantar flexion of 10° is achieved.

After 8 weeks, shoes with a high heel can be worn (cowboy boots).
Isometric exercises for the muscles of the lower limb (except calf muscles), light, actively performed dorsiflexion movements, i.e. the foot is pulled upwards so that the Achilles tendon is gently stretched.
Slowly increase the intensity and extent of the isometric movements of the Achilles tendon.
Slowly increase the passive range of motion and stretching of the Achilles tendon after 6 weeks.
Perform proprioceptive movement training and muscle strengthening exercises.
After 6 weeks, cycling is possible with the heel resting on the pedal. Training in deep water. Daily treatment of soft tissues.

8th – 12th week: Full load with heel increase (if bearable), gait training.
Wear normal shoes. Gradually increase the active exercises of the Achilles tendon, and also perform against resistance (that is, submaximal isometric, isotonic exercises, even with fitness band).
The complete passive range of motion of the Achilles tendon must be achieved without overstraining it.
Continue cycling and swimming training. You can drive a car with an orthosis.

3rd – 6th month: Remove heel elevation.
Perform exercises in a closed, kinetic chain, such as squats, lunges, double-sided toe stand, lifting the toes, slow eccentric contractions controlled by body weight.
The following activities are allowed: cycling, versaclimber, rowing machine, treadmill, unless there is excessive fibrosis; the exercise program can be completed directly at home.

6th month: Continue training: jogging/running, jumping and eccentric exercises.
The sports activities can be slowly resumed (no competitive and competitive sports), simulation exercises of the sports practiced.

8th – 9th month: Return to competitive sports and hard work.

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