Mayo Clinic Health Library

Achilles tendon rupture

Updated: 09-23-2011

Definition

Achilles (uh-KILL-eez) tendon rupture is an injury that affects the back of your lower leg. It most commonly occurs in people playing recreational sports.

The Achilles tendon is a strong fibrous cord that connects the muscles in the back of your calf to your heel bone. If you overstretch your Achilles tendon, it can tear (rupture). The tendon can rupture completely or just partially.

If you have an Achilles tendon rupture, you might feel a pop or snap, followed by an immediate sharp pain in the back of your ankle and lower leg that usually affects your ability to walk properly. Surgery is often the best treatment option to repair an Achilles tendon rupture. For many people, however, nonsurgical treatment works just as well.

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Symptoms

Although it's possible to have no signs or symptoms with an Achilles tendon rupture, most people experience:

  • Pain, possibly severe, and swelling near your heel
  • An inability to bend your foot downward or "push off" the injured leg when you walk
  • An inability to stand up on your toes on the injured leg
  • A popping or snapping sound when the injury occurs

When to see your doctor
Seek medical advice immediately if you feel a pop or snap in your heel, especially if you can't walk properly afterward.

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Causes

Your Achilles tendon helps you point your foot downward, rise on your toes and push off your foot as you walk. You rely on it virtually every time you move your foot.

Rupture usually occurs in the section of the tendon located within 2.5 inches (6 centimeters) of the point where it attaches to the heel bone. This section may be predisposed to rupture because it gets less blood flow, which may impair its ability to heal.

Ruptures often are caused by a sudden increase in the amount of stress on your Achilles tendon. Common examples include:

  • Increasing the intensity of sports participation
  • Falling from a height
  • Stepping into a hole
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Risk factors

Factors that may increase your risk of Achilles tendon rupture include:

  • Age. The peak age for Achilles tendon rupture is 30 to 40.
  • Your sex. Achilles tendon rupture is up to five times more likely to occur in men than in women.
  • Playing recreational sports. Achilles tendon injuries occur more often in sports that involve running, jumping and sudden starts and stops — such as soccer, basketball and tennis.
  • Steroid injections. Doctors sometimes inject steroids into an ankle joint to reduce pain and inflammation. However, this medication can weaken nearby tendons and has been associated with Achilles tendon ruptures.
  • Certain antibiotics. Fluoroquinolone antibiotics, such as ciprofloxacin (Cipro) or levofloxacin (Levaquin), increase the risk of Achilles tendon rupture.
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Preparing for your appointment

Because an Achilles tendon rupture can impair your ability to walk, it's common to seek immediate treatment at a hospital's emergency department. You may also need to consult with doctors specializing in sports medicine or orthopedic surgery.

What you can do
You may want to write a list that includes:

  • Detailed descriptions of the symptoms and the precipitating event
  • Information about past medical problems
  • All the medications and dietary supplements you take
  • Questions you want to ask the doctor

What to expect from your doctor
The doctor may ask you some of the following questions:

  • How exactly did this injury occur?
  • Did you feel or hear a popping or snapping sound when it happened?
  • Can you stand on tiptoe with that foot?
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Tests and diagnosis

During the physical exam, your doctor will inspect your lower leg for tenderness and swelling. In many cases, doctors can feel a gap in your tendon if a complete rupture has occurred.

The doctor may also ask you to kneel on a chair or lie on your stomach with your feet hanging over the end of the exam table. He or she may then squeeze your calf muscle to see if your foot will automatically flex. If it doesn't, you probably have ruptured your Achilles tendon.

If there's a question about the extent of your Achilles tendon injury — whether it's completely or only partially ruptured — your doctor may order a magnetic resonance imaging (MRI) scan. This painless procedure uses radio waves and a strong magnetic field to create a computerized image of the tissues of your body.

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Treatments and drugs

The best treatment for a ruptured Achilles tendon often depends on your age, activity level and the severity of your injury. In general, younger and more active people often choose surgery to repair a completely ruptured Achilles tendon while older people are more likely to opt for nonsurgical treatment. Recent studies, however, have shown fairly equal effectiveness of both operative and nonoperative management.

Nonsurgical treatment
This approach typically involves wearing a cast or walking boot with wedges to elevate your heel; this allows the ends of your torn tendon to heal. This method can be effective, and it avoids the risks, such as infection, associated with surgery. However, the likelihood of re-rupture may be higher with a nonsurgical approach, and recovery can take longer. If re-rupture occurs, surgical repair may be more difficult.

Surgery
Surgery is a common treatment for a complete rupture of the Achilles tendon. The procedure generally involves making an incision in the back of your lower leg and stitching the torn tendon together. Depending on the condition of the torn tissue, the repair may be reinforced with other tendons. Surgical complications can include infection and nerve damage. Infection rates are reduced in surgeries that employ smaller incisions.

Rehabilitation
After treatment, whether surgical or nonsurgical, you'll go through a rehabilitation program involving physical therapy exercises to strengthen your leg muscles and Achilles tendon. Most people return to their former level of activity within four to six months.

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Prevention

To reduce your chance of developing Achilles tendon problems, follow these tips:

  • Stretch and strengthen calf muscles. Stretch your calf to the point at which you feel a noticeable pull, but not pain. Don't bounce during a stretch. Calf-strengthening exercises can also help the muscle and tendon absorb more force and prevent injury.
  • Vary your exercises. Alternate high-impact sports, such as running, with low-impact sports, such as walking, biking or swimming. Avoid activities that place excessive stress on your Achilles tendons, such as hill-running and jumping activities.
  • Choose running surfaces carefully. Avoid or limit running on hard or slippery surfaces. Dress properly for cold-weather training and wear well-fitting athletic shoes with proper cushioning in the heels.
  • Increase training intensity slowly. Achilles tendon injuries commonly occur after a person abruptly increases his or her training intensity. Increase the distance, duration and frequency of your training by no more than 10 percent each week.
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