Achilles Tendon Rupture

Achilles tendon rupture is the tearing of the tendon that connects the calf muscle to the heel bone. This condition is marked by severe pain in the back of the ankle, swelling in the heel, and difficulty standing or walking.

The Achilles tendon is the strongest and largest tissue in the body. This tendon plays an important role in moving the ankle, for example for walking, running, tiptoeing, and jumping. However, movements that burden this tendon when it is too heavy can cause a tear in the Achilles tendon (Achilles tendon rupture).

Most Achilles tendon tears occur near the heel area. However, Achilles tendon rupture can also occur along the Achilles tendon to the calf area. The Achilles tendon can also be partially or completely torn, depending on the injury.

Causes of Achilles Tendon Rupture

Achilles tendon rupture occurs as a result of pressure that increases suddenly or very quickly on the lower leg. This condition can be caused by the following things:

• Performing movements that require a strong push from the calf muscles, such as stopping the leg suddenly or jumping
• Suffering an injury, such as falling, tripping, or spraining, with a position that makes the Achilles tendon stretch
• Suffering a deep puncture wound that penetrates the tendon on the back of the leg

Risk factors for Achilles tendon rupture

Achilles tendon rupture is more at risk of occurring in individuals with weak tendons due to several conditions. Some conditions that are risk factors for Achilles tendon rupture are:

• Aged between 30–40 years
• Undergoing treatment with quinolone antibiotics , such as ciprofloxacin , ofloxacin, or levofloxacin
• Get a corticosteroid injection near the tendon
• Taking corticosteroid drugs , such as prednisolone, in the long term
• Experiencing tendinitis or inflammation of the
• Achilles tendon
• Have a job or sport that uses the Achilles tendon a lot, such as running, basketball, or volleyball
• Have other medical conditions, such as diabetes,
• Cushing’s syndrome , thyroid disease, rheumatoid arthritis , gout, or lupus
• Suffering from excess weight ( overweight or obesity ), because it can put great pressure on the
• Achilles tendon
• Often wear high heels for activities that involve a lot of movement in the feet

Symptoms of Achilles Tendon Rupture

Symptoms of Achilles tendon rupture can be:

• Popping sound from the back of the ankle when injured or athletic
• Sharp pain that occurs suddenly near the heel
• Bruising and swelling on the back of the ankle
• Pain when the Achilles tendon area is pressed
• Pain when walking and limping
• Difficulty bending the injured leg downward
• Can’t tiptoe, run, or climb stairs with the injured leg

If the Achilles tendon is only partially torn, the sufferer will also experience pain, swelling, and bruising. However, the sufferer may still be able to walk and stand on the affected leg.

When should you go to the doctor?

Check with your doctor if you hear a popping sound in your heel accompanied by severe pain, especially if it occurs during exercise or as a result of an injury. The earlier the treatment is done, the higher the chance of recovery.

Immediately seek medical help or go to the nearest hospital if you experience severe pain to the point of difficulty walking.

Diagnosis of Achilles Tendon Rupture

To diagnose Achilles tendon rupture , the doctor will first ask about the following:

• The symptoms that occur and the activities performed when complaints appear
• Diseases that the patient has or is currently suffering from
• The treatment the patient is undergoing
• Occupation or hobby that may be related to the appearance of symptoms

After that, the doctor will perform a physical examination on the leg with:

• Pressing on the Achilles tendon area to check for pain and swelling
• Asking the patient to perform movements, such as walking, tiptoeing, or bending the legs
• Press the calf muscles to see the reflex in the leg that should move when the muscle is pressed

Generally, that series of tests is enough to diagnose a tear in the Achilles tendon. However, when necessary, the doctor can perform further examinations, such as USG, X-ray, or MRI of the foot to confirm the diagnosis.

Treatment of Achilles Tendon Rupture

People with symptoms of Achilles tendon rupture can do self-therapy before seeing a doctor. The goal is to reduce damage and ease pain. Self-care that can be done for Achilles tendon rupture is:

• Rest the sore leg and do not move it
• Do not massage a sore leg because it will worsen the condition
• Compress the leg with ice
• Wrap the sore leg with a bandage to reduce movement and prevent the leg from swelling
• Elevate the affected leg so that it is higher than the heart to reduce swelling
• Take pain relievers, such as paracetamol or naproxen

Keep in mind that the therapy above is not enough to cure Achilles tendon rupture . This condition still requires treatment by a doctor to be able to recover properly. Achilles tendon rupture medical actions that can be done by the doctor are:

Casting and leg support

If the Achilles tendon is only partially torn, the doctor will usually give a cast or leg brace. This is to limit movement at the ankle while the tendon heals on its own. The cast will usually be installed for 8 weeks with the foot bent down.

Operation

If the above methods are not successful in curing Achilles tendon rupture , the doctor will suggest a surgical procedure. Surgery will also be immediately recommended if the Achilles tendon is completely torn or occurs in people who are still working or doing a lot of activity.

Operation on Achilles tendon rupture can be done with an open method or arthroscopy. These two surgical methods both aim to sew up the torn tendon. During the recovery time from the operation, the patient still needs to use a cast or leg support.

Rehabilitation

Physical therapy is highly recommended for all Achilles tendon rupture patients , both treated with casts and surgery. The purpose is to strengthen the leg muscles as well as the Achilles tendon. The time required for a patient to fully recover from an Achilles tendon rupture is generally around 4-6 months.

Complications of Achilles Tendon Rupture

An untreated Achilles tendon rupture can cause a number of the following complications:

• The Achilles tendon is torn again
• Blood clots in the blood vessels of the legs
• Worsening or prolonged pain
• Chronic nervous disorders
• Difficulty walking
• Changes in shape or size in the area of the tendon or heel bone

Prevention of Achilles Tendon Rupture

Prevention of Achilles tendon rupture is to reduce the risk of being affected by this condition. It can be done by:

• Stretching and warming up before exercise , as well as cooling down after exercise
• Increase the intensity of sports or physical training regularly, not suddenly
• Alternate high-intensity sports, such as running, basketball, or volleyball, with moderate-intensity sports, such as jogging , cycling, or swimming.
• Do muscle exercises to strengthen the calf muscles
• Lose weight if suffering from obesity
• Limiting activities that put excessive pressure on the Achilles tendon, such as running uphill
• Using athletic shoes with soft cushions in the heel
• Avoid running on hard or slippery surfaces
• Do not consume drugs indiscriminately, but according to the rules of use according to the doctor’s recommendations
• Carry out routine check-ups with the doctor according to the schedule determined if you have certain chronic diseases

Gatz, M., et al. (2021). Open Versus Minimally-Invasive Surgery For Achilles Tendon Rupture: A Meta-Analysis Study. Archives of Orthopedic and Trauma Surgery, 141, pp. 383–401.
Tarantino, D., et al. (2020). Achilles Tendon Rupture: Mechanisms of Injury, Principles of Rehabilitation and Return to Play. Journal of Functional Morphology and Kinesiology, 5(4), pp. 95.
Cleveland Clinic (2021). Achilles Tendon.
Cleveland Clinic (2021). Achilles Tendon Rupture.
Mayo Clinic (2022). Achilles Tendon Rupture.
Cedars Sinai (2022). Achilles Tendon Injuries.
Johns Hopkins Medicines (2023). Achilles Tendon Injuries.
Healthline (2022). Your Guide to a Ruptured Achilles Tendon.
MedicineNet (2023). Achilles Tendon Rupture.
Patient Info (2023). Achilles Tendon Rupture.
Verywell Health (2022). Ruptured Achilles Tendon.