Achilles tendon rupture

istock photo of achilles tendonThe Achilles tendon is the big, strong tendon in the back of the heel that connects the calf muscles to the heel bone and assists in pushing the heel off the ground when walking, running, or jumping.

You may only hear about an acute rupture of the Achilles tendon when it happens to an elite athlete, but it’s actually a fairly common injury. It usually happens while playing sports or doing something that requires a quick, powerful motion.

A typical patient I see with a ruptured Achilles tendon might be a weekend warrior, somebody who sits at a desk all week but does fairly high-level activities at night or on the weekend—pickup basketball, for example—without much time to train or prepare their body.

What leads to a ruptured Achilles tendon?

We don’t know for sure why it happens to certain people. It could be that there’s some kind of breakdown of the tendon that has occurred over time, like tendinosis, that has made it weak.

And here’s an interesting thing to know about these injuries: I’ve seen hundreds and hundreds of Achilles tendons in clinic, and I’ve found that people who have chronic Achilles tendon issues—for months or even years—rarely end up rupturing the tendon. And on the flip side, people who have a rupture almost never report having had any issues with their Achilles tendon prior to the injury.

What treatment options are available?

There’s been a big shift in recent years in what we recommend for treatment. The average person can return to normal function without surgery.

Historically, many patients had surgery. That worked well to repair the tendon, but the patients had a fairly high complication rate. There were issues with the wound healing and with infections.

And people who didn’t have surgery tended to have a higher chance of rupturing the tendon again. They didn’t seem to heal quite as well, and they didn’t come back as strong as those who had surgery.

“We probably most often hear about an acute rupture of the Achilles tendon when it happens to elite athletes, but it’s actually a fairly common injury.” – Mederic Hall, MD

Over the last 10 years, we’ve changed our approach. We’ve gotten a lot more aggressive. Instead of putting patients in a cast, we get them moving relatively quickly. Several studies have found that if you treat an Achilles tendon tear without surgery and get the patient rehabbing sooner, the functional outcome is about the same as those who had surgery.

Obviously, the decision about whether to have surgery depends on a lot of factors that vary from case to case.

For an elite athlete considering a professional career, where every last bit of speed and power really matters, they’ll probably opt for surgery. But most recreational athletes—even the most active, competitive folks—will do just as well if they choose a nonsurgical treatment.

Last reviewed: 
September 2017

Interested in using our health content?