Ruptured Achilles Tendon: What You Need to Know
The Achilles tendon is the strongest, largest, and most often injured tendon in the body. It's a combination of the two muscles along the back of the lower leg that join to become the Achilles tendon, which connects to the heel. A weak Achilles tendon is vulnerable to injury. When the top of the foot is pushed back toward the skin by a sudden movement, the tendon can be stretched to the point of tearing.
Part of the problem is that you usually have no indication that your tendon is weak or susceptible to an injury. There are very few, if any, warning signs. In one study, 85 percent of Achilles ruptures involved a condition called tendinosis (or tendonitis), dead areas of tissue within the tendon that don't cause pain.
The good news: You don't always need surgery to fix the Achilles tendon, and almost every athlete or exerciser can return to normal sports activities once it's healed. Recovery can take several months, depending on the extent of the injury.
How a Ruptured Achilles Tendon Happens
The cause of a ruptured Achilles tendon is an unusually strong contraction of the calf muscle that stretches the tendon to the point of tearing or breaking. A previous injury might have already weakened the tendon or there may be an imbalance between the strength of the tendon and the strength of the two calf muscles, which creates tremendous stress on the tendon. Not warming up properly and exercising in cold weather can also contribute to the injury..
Ruptured Achilles Tendon by the Numbers
Average age of a person who sustains an Achilles tendon rupture.
Percentage of people who suffer from an Achilles tendon ruptures who are professional or white collar workers.
Who’s at Risk for a Ruptured Achilles Tendon
The person most likely to suffer an Achilles tendon rupture is a man over the age of 30 who is a weekend warrior and plays basketball or tennis. Others at risk are racquetball and badminton players, gymnasts, soccer players, runners, track and field athletes, and dancers. Between six and 18 percent of runners have Achilles tendonosis, which could be a precursor to an Achilles tendon rupture. This injury is more common in men than in women, but that may reflect the greater number of men who participate in sports and exercise programs compared to women.
- Popping or snapping sound
- Sudden pain in the lower leg or at the back of the ankle
- Swelling near the heel
- Depression approximately two inches above the heel bone
- Bruising, weakness after the initial pain, swelling, and stiffness
- An inability to walk normally, bend your foot downward, push off when walking or rise on your toes (of the affected leg).
- Apply ice 15-20 minutes at a time, 3-4 times per day.
- Rest (immobilization)
- Compression (using an elastic wrap to control swelling), but not tight enough to cut off blood supply
- Elevation (2-3 hours during the day and at night, if practical)
- Aspirin, acetaminophen, ibuprofen, and naproxen may relieve pain and reduce inflammation.
- Have a sports medicine physician examine your leg as soon as possible.
How soon you can return to your sport or exercise program depends on the quality of your rehabilitation program and your commitment to it. With or without surgery, you’ll probably be sidelined for 4-6 months. Elite athletes may return as early as three months after the injury. Most people who have sustained this injury are able to return to normal sports activities at some point.
Some physicians recommend surgery, while others do not. Younger, more active athletes often prefer surgery and are able to return to action sooner than those who choose the non-surgery option. Once you're back in the game, apply ice for 15 to 20 minutes after exercise as an ongoing treatment.
To help decrease your risk for injury, incorporate the prehab exercises below recommended by the physical therapists at Athletes’ Performance:
- Acceleration Wall Drill - Posture Hold – helps build running posture.
- Knee Hug - Moving – builds strength, stability, mobility, and bolsters running mechanics.
- Pillar Skip - In Place – helps make you springier out on the road.
- Squat - Single Leg Balance – works your glutes, quads, and hamstrings.
- Romanian Deadlift 2 Arm / 1 Leg – helps lengthen and strengthen your hamstrings, glutes, and lower back.
- Lunge Stretch – challenges your body's balance, stretches your hip flexors, and strengthens your glutes.
How to Avoid a Ruptured Achilles Tendon
If you think you're at risk for a ruptured Achilles tendon, here are some things you can do to help reduce your risk of injury.
- Wear shoe inserts to redistribute the forces placed on the Achilles tendon.
- Wear shoes that have added cushioning in the heels.
- Reduce the intensity, duration, or frequency of exercise that puts the Achilles tendon at risk.
- Avoid activities that are certain to place stress on the lower leg and Achilles tendon (jumping or running on hills).
- Alternate between high impact and low impact sports (running versus swimming, walking or cycling).
- Perform the prehab exercises listed above as well as the moves below.
To reduce your risk of Achilles tendon injuries, include the moves below in your Movement Prep routine. Together, these movements help stretch your calves, strengthen your glutes, and improve torso stability to help you run with great technique.
- Mini Band - External Rotation
- Mini Band - Straight Leg Lateral Walk
- Mini Band - Bent Knee Lateral Walk
Jim Brown, Ph.D. has written 14 books on health, medicine, and sports. His articles have appeared in the Washington Post, New York Post, Sports Illustrated for Women and Better Homes & Gardens. He also writes for the Duke School of Medicine, UCLA School of Medicine, Cleveland Clinic and Steadman-Hawkins Research Foundation.
- Angela Smith, MD, Pediatric Orthopaedic Surgery, Children’s Hospital of Philadelphia, Clinical Associate in Orthopaedic Surgery, University of Pennsylvania
- Steve Smith, PT, DPT, SCS, CSCS, Manager, Performance Physical Therapy Services Athletes’ Performance, Florida
- Journal of the American Board of Family Practice
- Penn State Sports Medicine Newsletter