Achilles Tendon Tear

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The Achilles tendon is a large tendon at the back of the lower leg and ankle that connects the calf muscles to the heel.  It is the largest  tendon in the body, and its strength allows us to push off with forces  up to 10 times our body weight. 

An Achilles tendon tear, or rupture, usually is a complete gap between the upper and lower portions of this tendon.  It most often occurs 2-3 inches above the heel bone but can be directly at the attachment or higher in the leg.

A tear usually occurs during activities such as running and jumping, or trauma such as a slip and fall. Most patients report their first feeling was a "pop" or like they were struck in the back of the ankle, followed by some pain.  There often is no pain in this area before the actual tear.  After the tear, patients complain of weakness when pushing off of their foot during walking or when trying to stand on tiptoe. There may be a small bruise on the inside of the heel during the first few days. 

Your foot and ankle surgeon often  performs an examination  to make a diagnosis. Y ou will lie in a facedown position with your  ankles off the edge of the exam table.  When the Achilles tendon is not torn, it is taut and the ankle lies in a toe down position of approximately 20 degrees. Squeezing the upper calf will cause the toes to point down even further.

If the tendon is torn, it does not have this tension and the ankle usually will hang  at about a 90-degree angle.  Squeezing the upper calf will cause weak or  no movement.  Your surgeon will lightly pinch the Achilles tendon 2-3  inches above the heel to determine if there is a gap.  Special tests such as ultrasound,  X-rays, and MRI scans typically are not helpful but can be in some  instances.

At first, the leg is placed at rest in a splint or special boot.  It is important to see a foot and ankle surgeon soon after the  injury so the best treatment can be started within a few days.

Both  non-surgical and surgical treatments have been well studied but remain  debated. In general, surgical treatment is thought to give greater strength and result in a lower risk of repeat tear.  However, surgery has  an increased risk of wound healing  problems, nerve damage, and infection plus the usual risks  associated with surgery.  Blood clots are a concern with both types of  treatment. Your foot and ankle surgeon will be the best person to guide you through the pros and cons and help you to select the best option. 

Surgical Treatment

In this surgery,  your foot and ankle surgeon will place stitches into the tendon above and below the area of the tear and then pull the ends together.  This is because the actual tear  appears similar to two wet mops with multiple uneven strands that need  to be brought together.  The stitches can be applied through one or more incisions (viewing the tendon  directly) or through multiple small incisions (placing the sutures  through the tendon using a guide).  The recovery after surgery is similar  to the non-surgical treatment but can be slightly shorter. 

Since tendons do not have a great blood supply, healing is a slow  process. Patients usually can start light jogging in 3-6 months with  return to sports involving cutting and jumping in 6-9 months. Full  return of strength and the feeling of being normal may take more than a year. 

Is there anything I can do to prevent tearing the Achilles tendon?
Achilles  tendon tears occur so rarely that there is no study that really answers this question well. A stretching program for the Achilles tendon makes sense but the benefit has not been well shown.  That being said, there is no  downside to stretching the tendon and it should be part of every athlete's warm up.  Smoking should be avoided as the negative effects of  cigarettes on tendon health have been well shown. 

After an Achilles tendon tear, how likely am I to tear the other side?
About 6% of patients with an Achilles tendon tear will have the same injury in the other foot.

Is there anything I can do to make the tendon heal faster?
Starting  range-of-motion exercises and putting weight on the injured leg early have shown better results than long periods of immobilization on  crutches.  However, it has to be balanced by the risk of pulling apart the ends of the tendon if you stretch too much too early.  Stopping smoking for at least a few months while the tendon heals also is likely to be of benefit.