Whatianga iohere punga Achilles tendon rupture
Your Achilles tendon attaches your calf muscle to your heel. When some or all of the tendon's fibres tear, we call this a rupture. This often happens after a sudden force on the foot or ankle, such as suddenly breaking into a sprint while playing sport. It makes it difficult or impossible to stand on tiptoes.
Causes of Achilles tendon rupture
Most Achilles tendon ruptures are sports related and often happen after a quick movement such as suddenly jumping and sprinting. This most often happens in sports that involve a lot of stopping and starting such as tennis, basketball, netball, football and squash.
Things that may increase the risk of Achilles tendon rupture include:
- having frequent episodes of Achilles tendinopathy (a condition that can cause pain, stiffness and swelling of the Achilles tendon)
- being between 30 and 50 years old — Achilles tendon ruptures are more common in this age group
- being male
- starting a new sport or increasing the amount of exercise you do too quickly
- having a poor running technique
- being overweight — extra weight puts more strain on the tendon
- taking some medications, for example steroids or some antibiotics such as ciprofloxacin
- having a medical condition that can weaken the tendons, such as rheumatoid arthritis or diabetes.
Symptoms of Achilles tendon rupture
If you rupture your tendon, you are likely to have a sudden, sharp and severe pain in the back of your leg. People often describe it as feeling like someone has hit them on the back of the heel. The pain usually settles down into a dull ache.
Symptoms may also include:
- swelling in your calf
- difficulty walking and not being able to put your full weight on your injured leg or stand on tiptoe
- bruising on your lower leg.
If your tendon is completely torn, you may feel a gap just above the back of your heel.
Diagnosing a ruptured Achilles tendon
Your healthcare provider will diagnose a ruptured Achilles tendon by listening to your explanation of what happened and examining you. You usually will not need scans or x-rays.
If the diagnosis is unclear, your healthcare provider may advise you to have an ultrasound or MRI scan.
Treating a ruptured Achilles tendon
Surgery to stitch the tendon back together or non-surgical measures (conservative treatment) are both used to treat ruptured Achilles tendons.
An orthopaedic surgeon will talk to you about your treatment options. Your treatment will depend on several factors including your age, your general health and how active you are.
Recovery takes 3 months whether you have surgery or conservative treatment. In both cases you will spend about 2 weeks in a plaster cast followed by a moonboot for 4 weeks, then physiotherapy.
You will get a plaster cast on your leg either on its own or straight after surgery. Casts for ruptured Achilles tendons usually go from your knee downwards and keep your toes pointing down — this is called the equinus position. This brings the 2 ends of the torn tendon together allowing it to heal.
While the cast is on, you will not be able to put any weight on this leg and will need crutches to move around.
If you are at all worried about your cast, contact the place where it was put on or your primary healthcare provider.
If you need any other mobility aids or help at home, the orthopaedics team or your healthcare provider can let you know how to get this. ACC might be able to help.
To keep your foot from moving when the plaster is removed, you will be fitted with a special hinged splint known as a moonboot. A moonboot is a rigid type of boot with velcro straps to adjust it. It usually fits from your knee downwards. You will get a prescription for a hinged moonboot when you get your plaster cast.
You should not put your weight on the moonboot when walking so you will still need to use crutches. You can take it off for a shower (taking care not to put weight on your injured leg). You will need to wear the moonboot day and night.
If you are being treated with a splint, you will need to wear a custom made splint when your cast is taken off. The treatment centre will make you a custom-fitted splint.
You will not be able to put your weight on your leg while you are in the splint, but you will be able to take it off to shower. You will need to wear the splint day and night.
No matter how you are treated, you will spend some time with heel raises in your normal shoes. This is to remove strain from the Achilles tendon, so it does not tear again. These are usually fitted to 2 pairs of shoes.
You will be able to start putting weight through your leg once the heel raises are fitted. At first, you will need crutches. When going upstairs, take care to put your whole foot on the step so you do not put extra stress on your tendon.
When you get up at night to go to the toilet, make sure you put your shoe on or use your crutches. Be careful not to slip when you are in the shower or bath.
You may need physiotherapy to help you to learn to walk again, as you do not want to stretch your tendon too quickly. It will slowly stretch back to normal as you walk. Your healthcare provider will tell you at your next appointment if you need physiotherapy.
Some swelling is normal, but you will get a Tubigrip bandage to help control this. Make sure you take the bandage off at night.
If you have any concerns during your treatment, contact your healthcare provider.
Recovery after a ruptured Achilles tendon
Recovering from a ruptured Achilles tendon can take several months. Progress may seem slow, but it is important not to try to rush the process as you may cause more damage.
Your physiotherapist will tell you what exercises to do, when and for how long. Ask them about anything you are not clear about.
- Your leg will be in a plaster cast or back slab (a half cast around the back of your leg and ankle).
- You will not be able to put any weight on your leg or foot.
- You will wear a moonboot that holds your foot in a downward position. Wear it all the time, except when exercising, sitting or bathing.
- You will gradually work up to putting some weight (no more than half your weight) on your leg and foot.
- You will start physiotherapy. Your physiotherapist will give you exercises to do with your foot off the ground or while you are lying down. They will also give you hip and knee exercises to maintain the strength in your leg. Pain is your guide — if it hurts, stop.
- Do all these exercises up to 5 times a day.
- The angle of your foot within the moonboot will change. Wear the moonboot at all times, except for when you are exercising or bathing.
- Gradually start putting more weight through your leg and foot, up to 100% of normal by the end of week 6.
- Continue with the same exercises.
- Your foot will now be in a neutral position in the moonboot.
- With your boot on you can put as much weight through your leg and foot as you can bear without discomfort.
- Take the boot off regularly and do the non-weight-bearing exercises your physiotherapist has given you for your ankle.
- You can take your boot off at night, but make sure you put it back on before doing any walking.
- You can start wearing your own footwear if it is supportive — running shoes are fine, jandals are not.
- Use a Tubigrip bandage to control any swelling.
- Use crutches as you need to but try to gradually stop using them within the next 2 weeks.
- Your physiotherapist will give you exercises to help with walking and standing.
- Your tendon is still very vulnerable — take care when exercising and with everyday activities.
- If something hurts, stop.
- Your exercises will now aim to build strength and balance and increase your range of movement.
- You can now begin sport-specific retraining, but it may take 6 months before you can get back to full sporting activity.