Achilles tendon rupture

An Achilles tendon rupture is a complete or partial tear of the thick band of tissue that connects the calf muscles to the heel bone.

The injury typically happens during sudden, explosive movements, such as sprinting or jumping, and is often accompanied by an audible pop or a sensation of being kicked in the back of the leg. This article outlines the diagnosis, management choices, and recovery timeline for patients.

What happens when the Achilles tendon ruptures?

When the Achilles tendon ruptures, the mechanical connection that allows the calf muscles to pull on the heel bone is broken, making it difficult or impossible to push off the toes normally. It’s a common injury among recreational athletes, with clinical data showing it most frequently affects individuals between the ages of 30 and 50.

The tear usually occurs in a section of the tendon that has a vulnerable blood supply, roughly two to six centimetres above where the tendon attaches to the heel. Without prompt medical attention, the ends of the torn tendon can retract, which can complicate the healing process and lead to long-term weakness.

Research indicates that early immobilisation is vital to prevent further separation of the tendon ends and to ensure the best possible functional recovery.

When should a patient seek a specialist orthopaedic assessment?

A patient should seek an immediate specialist assessment if they suspect an Achilles tendon injury, especially if they cannot lift their heel off the ground or walk comfortably. A specialist evaluation involves performing specific clinical tests, such as the Simmonds' test, to confirm the diagnosis.

During this test, the patient lies face down and the surgeon squeezes the calf muscle; if the foot doesn't move, it indicates a complete rupture. An urgent ultrasound scan is also arranged to assess the exact location of the tear and to measure the gap between the tendon ends.

What are the primary treatment pathways?

The management of an Achilles tendon rupture can be non-surgical or surgical, depending on the patient's age, physical activity demands, and the specific nature of the tear. Orthopaedic specialists discuss both options with the patient to determine which pathway aligns best with their lifestyle goals.

• Functional rehabilitation: A non-surgical approach using a sequence of specialised boots with wedges that gradually lower the heel, allowing the tendon to heal naturally without an operation.
• Open surgical repair: A traditional procedure where a single incision is made over the tendon to allow the surgeon to stitch the torn ends back together directly.
• Minimally invasive surgery: A modern technique using smaller cuts to stitch the tendon, which lowers the risk of wound healing complications and infection.
• Tendon transfer: A complex reconstructive surgery reserved for chronic or neglected ruptures where a nearby tendon is used to reinforce the weakened Achilles.

What does the rehabilitation process look like?

Rehabilitation from an Achilles tendon rupture is a prolonged process that requires several months of structured physical therapy to rebuild calf muscle volume and joint flexibility. Whether managed surgically or non-surgically, patients spend the first few weeks in a protective boot, gradually transitioning to full weight-bearing.

Studies suggest that the risk of re-rupture is low; under five per cent for both treatment pathways when a strict functional rehabilitation protocol is followed. Most patients can return to light exercise within four to six months, while a full return to high-impact sports generally takes up to nine to twelve months of dedicated training.

References

• British Orthopaedic Foot & Ankle Society (BOFAS). (2025). Patient Information on Achilles Tendon Ruptures.
• Royal National Orthopaedic Hospital (RNOH). (2024). Achilles Tendon Rehabilitation Guidelines.
• National Institute for Health and Care Excellence (NICE). (2023). Management of acute Achilles tendon rupture.
• The Bone & Joint Journal. (2022). Surgical versus non-surgical treatment of acute Achilles tendon rupture: a multi-centre randomized trial.