An Achilles tendon rupture is a serious injury, especially seen in active individuals who are engaged in sports. It usually occurs during a sudden movement, and at the moment of rupture, one may feel severe pain, a gap at the heel, loss of push-off strength in the foot, and sometimes even hear a “popping” sound.
Achilles tendon rupture requires Achilles tendon surgery because the torn ends of the tendon need to be stitched back together. If left untreated, it can lead to long-term limitations in basic movements such as walking and running.
What Is the Achilles Tendon?
The Achilles tendon is located at the back of the ankle. It connects the calf muscles, which start from behind the knee and run down the back of the lower leg, to the heel bone.
Its main function is to point the foot downward (similar to pressing the gas or brake pedal). It is the largest tendon in the human body. The Achilles tendon carries a heavy load, especially during walking, running, and jumping.
How Does the Achilles Tendon Rupture?
It can occur during sports such as football or basketball, usually at the beginning or end of a jumping movement. It may also happen in daily life—for example, when transitioning from walking to running, or when jumping down from a high place like a wall. If the calf muscles contract suddenly and forcefully, the Achilles tendon can tear.
Why Does the Achilles Tendon Rupture?
Achilles tendon rupture most often occurs during sports, but in some cases, even minimal strain can cause it. The most common reasons include:
- Intense Sports Activities: Especially basketball and football, which involve sudden starts and stops.
- Age and Degeneration: As we age, tendons lose their elasticity, making them more prone to rupture.
- Sudden Movements: Even outside of sports, sudden take-offs or rapid changes in direction can put excessive stress on the tendon, leading to rupture.
What Are the Symptoms of Achilles Tendon Rupture?
At the moment of injury, you may hear a popping sound that can also be heard by people nearby. Pain and swelling occur right above the Achilles tendon. The most important finding is difficulty walking. Most patients cannot point their foot downward (the motion used when pressing the brake or gas pedal).
Common Symptoms of Achilles Tendon Rupture
- Popping Sound: At the time of injury, a popping sound loud enough for others to hear may occur.
- Pain: Pain and swelling appear just above the Achilles tendon at the back of the ankle.
- Difficulty Walking: Once the Achilles tendon ruptures, it loses its function, leading to significant walking difficulties. Most patients cannot point their foot downward (brake–gas pedal motion).
- Swelling and Tenderness: The area around the Achilles tendon may become swollen, red, and sensitive to touch.
- Inability to Stand on Tiptoes: Patients are unable to lift their heel off the ground and rise on their toes.
- Gap in the Calf Muscle: A hollow or gap may be felt under the skin at the site of rupture.
- Limping and Difficulty Standing: Walking often causes limping, and standing upright becomes difficult.
- No Response in Thompson Test: Normally, squeezing the calf muscle makes the foot move downward. If the tendon is ruptured, this movement does not occur.
How Is Achilles Tendon Surgery Performed?
The surgery is performed through a parallel incision made next to the ruptured tendon. A cut of about 5 cm is made to expose both ends of the torn tendon. After cleaning the edges of the rupture, the tendon is stitched together using high-strength sutures with a special repair technique. The skin is closed with sutures that do not require removal. Once the closure is complete, a waterproof dressing is applied to cover the wound.
As Op. Dr. Utku Erdem Özer, I do not use a traditional plaster cast after Achilles tendon surgery. Instead, I prefer applying a plaster boot. When fitting the plaster boot, three wedges are placed under the heel to prevent the tendon stitches from being stretched and loosened in the early phase.
You can watch the Achilles tendon repair surgery performed by Op. Dr. Utku Erdem Özer by clicking the link.
In cases where plaster is applied, the foot is positioned downward at the ankle and a cast extending from below the knee to the toes is placed. In the third week, this cast is removed and replaced with a ready-made plaster boot.
Recovery After Achilles Tendon Repair Surgery
In the first few days after surgery, the focus is on pain control and wound healing. To reduce pain and control swelling, patients are usually advised to rest, apply ice, and take prescribed pain medications.
Additionally, keeping the leg elevated and walking without bearing weight while using supportive shoes such as a high-heeled shoe or a walking boot is recommended. The following outlines the recovery process in the weeks after surgery:
Recovery During the First 3 Weeks After Surgery
If your doctor approves, you may be discharged and go home the same day after Achilles tendon surgery. Mild aching pain may last for 1–2 days and can be managed with oral painkillers.
Without putting weight on the operated leg and using two crutches, you can move around the house, go to the bathroom, take a shower, and even return to short working hours if necessary. However, to minimize pain and swelling, it is important to lie in bed with your leg elevated above heart level by placing a pillow underneath.
A wound check and dressing change are usually done one week after surgery. After that, you may begin hip and knee exercises under the guidance of your physiotherapist. By the end of the second week, the wound is expected to be healed and usually does not require further dressing changes.
During this period, in addition to manual therapy and hip–knee exercises performed under medical supervision, toe exercises are initiated. Before the end of the third week, you must avoid actively moving the repaired Achilles tendon.
Recovery Between the 3rd and 8th Week
For the first 21 days, you must not put any weight on the operated leg. Your foot can touch the ground inside the boot, but no load should be applied. After 21 days, partial weight bearing with crutches is allowed.
At the end of the 3rd week, the first of the three heel wedges inside the plaster boot is removed. At the end of the 4th week, you may walk with crutches while gradually loading the operated leg.
One wedge is removed at the end of each week in the 5th and 6th weeks. By the end of the 6th week, no wedges remain in the boot. At this stage, you may continue walking with a single crutch for another week with the boot in a neutral position.
In the 7th week, both the plaster boot and crutches are discontinued. By the 8th week, the patient is able to wear regular shoes and walk without support.
After the 3rd week, physiotherapy exercises are especially important to prevent calf muscle wasting. These exercises must be performed under the supervision of an experienced physiotherapist.
How Long Does It Take for Achilles Tendon Rupture to Heal?
In most cases, complete recovery and return to normal activities require 4 to 6 months. However, the healing time varies depending on age, overall health, and the patient’s response to treatment.
Some patients may recover faster, while in others the process can take longer. A structured physiotherapy and rehabilitation program can accelerate healing and help the tendon regain flexibility and strength.
What Happens If the Achilles Tendon Ruptures?
Achilles tendon rupture usually occurs due to sudden strain or repetitive stress and is often accompanied by severe pain.
A ruptured tendon significantly affects mobility and walking ability, and in severe cases, it may lead to complete loss of movement if not treated.
Can an Achilles Tendon Rupture Heal Without Surgery?
Non-surgical treatment may be an option for elderly patients, those who are not physically active, or patients with high surgical risks. In this method, the ruptured tendon is immobilized in a specific position using a special walking boot (orthosis) or plaster cast.
The goal is to bring the torn ends of the tendon close together, allowing natural healing.
How to Prevent Achilles Tendon Rupture?
- Regular stretching: Improves tendon flexibility and durability.
- Strengthening exercises: Strengthening calf muscles reduces stress on the tendon.
- Warm-up before exercise: Prepares the tendon for sudden loads.
- Avoiding sudden movements: Caution is needed during sprinting, jumping, or quick direction changes.
- Proper footwear: Supportive sports shoes that reduce strain on the tendon should be chosen.
- Avoiding overtraining: Rest periods must be respected to prevent tendon overuse and degeneration.
Individuals with a history of Achilles tendinitis are advised to undergo professional assessment and follow a personalized exercise program before returning to sports.
Conclusion
Achilles tendon rupture can be successfully managed with a properly performed surgical repair and a structured rehabilitation program. Early diagnosis and timely intervention accelerate healing and make it easier for patients to return to daily and sports activities.
If you suspect such an injury, you can contact Op. Dr. Utku Erdem Özer, based in Şişli, Istanbul, via WhatsApp.
Thank you for reading. You can also visit the homepage of utkuerdemozer.com for more information. For more details, you can contact us or directly make an appointment.
