A total tear in the Achilles tendon can happen in any part of its length. It is a sudden, traumatic injury. When the tendon snaps, it leaves two broken ends which may stay close together or spring apart, leaving a visible dent. There may also be bruising.

Achilles Tendon Rupture

Rupture is very rare in children, uncommon in teenagers, and happens most often to people in early and later middle age.

What you Feel When you Have Achilles Tendon Rupture

You feel as if something has hit you hard in the back of the leg. If you try to walk, you stumble or fall over. Your foot feel floppy: you can draw the foot upwards into dorsiflexion, but while toes can still move downwards into flexion, you cannot point the foot down at the ankle. If you lie on your stomach, the foot falls to a right angle. If the gastrocnemius muscle is squeezed, the foot does not move as it normally would: this is a standard test for Achilles tendon rupture, and does not cause pain.

Causes for Achilles Tendon Rupture

Although the rupture can be caused by a direct blow to the back of the leg when the calf is under tension, more often it is intrinsic, with no obvious cause. It usually happens late in an exercise session or competition, and is associated with fatigue and circulatory problems rather than being cold or not warmed up properly. You may have had previous warning signs, such as tightness, cramping or involuntary twitching in the calf. You may have been stressed, overtired or suffering from an infection. The tendon may have been weakened by previous injury or injection, or overworked by compensating for a previous thigh or foot injury.

Treatment for Achilles Tendon Rupture

The foot must be supported immediately with bandaging or taping in the plantarflexed position, pointing down from the ankle. Avoid putting weight through it: hop using crutches. If you have to put the foot down, keep the leg away from your body turned out sideways, and try to keep your weight on the heel.

Seek specialist advice as quickly as possible. You have the choice of an operation or non-intervention. Surgery can be done through a scar as open surgery.

Non-intervention is a choice between either immobilisation in a plaster cast for several weeks, or support in a removable walking boot which allows weight-bearing, remedial therapies, exercises and alternative training to commence immediately. You should decide with your doctor which approach you want to use, and then follow all instructions to the letter.

Read more about Achilles Tendon Injury: Should I go for Surgery?.

Rehabilitation Phases

In all cases the foot is held pointing downwards in plantarflexion for the first phase, as the tendon has to be prevented from lengthening as it heals. If it is not in plaster, the leg can be taped to hold the position. Crutches are used as directed by the specialist. In the case of the walking boot they may not be needed for long, but should be used when exercises are done without boot on.

Rehabilitation starts with calf strengthening holding the Achilles tendon in a shortened position. Progression through the rehabilitation phases should generally be pain-free. However, sometimes following open surgery there is a moment when some movement causes a tearing sensation around the scar, almost as if the injury has happened again. This is usually due to adhesions round the scar breaking, and does not interfere with your progress to fitness. If in doubt, refer back to your doctor.

The tendon can be strained or suffer a minor tear at its attachment to the calcaneus. Sometimes the bursa between the tendon and the upper part of the bone becomes inflamed. In a chronic problem, spurs may form on the calcaneus. A spur can become detached, forming a focal point of pain. Achilles insertion problems can occur at any age. In children it is often linked to Sever’s disease.

Achilles Tendinitis

What you Feel When you Have Achilles Tendon Insertion Strain

Pain usually comes on gradually, although it can happen suddenly. You feel pain on tiptoeing or running. The heel is tender when you press on it. In the early stages the pain may wear off when you are warmed up, but recurs later during your exercise. The tendon gradually tightens. There is little or no pain at rest unless there is direct pressure on the heel.

Causes for Achilles Tendon Insertion Strain

There is usually excessive strain on the calf in extreme ranges of movement, for instance when you run uphill as fast as you can. Shoes contribute if they have rough, uneven linings round the heel; if the heel counter is soft, tight or not the right shape for your foot; if the sole is hard; or if the heel has worn down unevenly.

Treatment for Achilles Tendon Insertion Strain

Check your shoes and discard any which chafe, if padding does not help. You may benefit from orthotics. Your doctor or specialist may offer you an injection.

Ruptured Achilles Tendon

Brief Outline of Achilles Tendon Strain

Achilles tendon strains can be very painful and take some time to heal. The Achilles tendon, which gets its name from the mythological Greek warrior Achilles, is located in the back of the lower leg over the heel. An injury to this tendon can be debilitating because of its involvement in walking and even balance during weight bearing. Explosive activities such as sprinting and jumping, and those activities that involve pushing against resistance such as football linemen and weight training, contribute greatly to this injury.

Achilles Tendon Rupture

Anatomy and Physiology for Achilles Tendon

The Achilles tendon is the largest tendon in the human body, being approximately 15 cm long, and 2 cm thick. It originates from the musculo-tendinous junction of the calf muscles, and inserts into the posterior aspect of the calcaneus. The tendon is separated from the calcaneus by the retrocalcaneal bursa, and from the skin by the subcutaneous calcaneal bursa. It pulls the foot downward, extending it when the calf muscles contract. The strain can be graded on a scale from 1 to 3.

Grade 1 strain: A stretching or minor tear of the tendon (less than 25% of the tendon.)

Grade 2 strain: Involves more of the tendon fibres (usually 25% to 75%.)

Grade 3 strain: A complete rupture of the tendon.

Ruptured Achilles Tendon


Cause of Achilles Tendon Strain

Abrupt, forceful contraction of the calf muscles; especially when the the muscle and tendon are either cold or inflexible. Excessive force applied to the foot, forcing the foot into the plantar flexion.

Signs and Symptoms of Achilles Tendon Strain

Pain in the Achilles tendon, from mild discomfort in grade 1 strains to severe, debilitating pain in the grade 3 strains. Swelling  and tenderness may also be experienced. Pain when rising on the toes. Stiffness in the calf and heel area after resting.

Complications If Left Achilles Tendon Strain Unattended

A minor tear may become a complete rupture if left unattended. Bursitis and tendinitis may develop from the inflamed tendon rubbing over the heel.

Immediate Treatment to Achilles Tendon Strain

R.I.C.E. Anti-inflammatory medication. Then Shockwave Therapy to promote blood flow and healing. Immobilisation and medical help for complete ruptures.

Rehabilitation and Prevention for Achilles Tendon Strain

Rest is important and a gradual return to activity must be undertaken. Stretching and strengthening the calf muscles is important in rehabilitation and to prevent a recurrence. Warming-up the calf muscles properly before all activities, especially those involving forceful contractions such as sprinting, is essential to prevent strains.

Long-term Prognosis for Achilles Tendon Strain

Due to lower blood supply in tendons, they take longer to heal than the muscle, but with rest and rehabilitation, the Achilles tendon can return to normal function. Complete ruptures occasionally require surgical repair.

Call (+65) 6471 2674 (24 Hour) to fix an appointment to see our orthopaedic specialist for Achilles tendon treatment today.


Achilles Tendinitis

Achilles Tendinitis Video

Brief Outline of Achilles Tendinitis

Inflammation of the Achilles tendon can be very painful, especially since all of the body’s weight is supported by this structure and the shoe often presses against this area. Repetitive stress to the tendon can lead to inflammation that causes additional irritation, causing more inflammation. Activities such as basketball, running, volleyball, and other running and jumping sports can lead to Achilles tendinitis.

Anatomy and Physiology of Achilles Tendinitis

The Achilles tendon is the largest tendon in the human body, being approximately 15 cm long, and 2 cm thick. It originated from the musculo-tendinous junction of the calf muscles and inserts into the posterior aspect of the calcaneus. The tendon is separated from the calcaneus by the retrocalcaneal bursa, and from the skin by the subcutaneous calcaneal bursa. The tendon crosses the back of the heel, which means it rides over the bone as the muscle contracts and stretches. Repetitive contraction of the muscles in the calf and improper footwear or excessive pronation of the feet can lead to inflammation in the tendon.

Achilles Tendinitis

Right Foot Tendon is Thicker than Left Foot Tendon

Cause of Achilles Tendinitis

Repetitive stress from running and jumping activities. Improper footwear or awkward landing pattern of the foot during running. Untreated injuries to the calf or Achilles tendon.

Signs and Symptoms of Achilles Tendinitis

Pain and tenderness in the tendon. Swelling may be present. Contraction of the calf muscle causes pain; running and jumping may be difficult.

Complications If Left Achilles Tendinitis Unattended

Inflammation in the tendon can lead to deterioration of the tendon and eventual rupture if left untreated. Inflammation may lead to tightening of the tendon and attached muscle, which could lead to tearing.

Immediate Treatment for Achilles Tendinitis

Rest, reducing or discontinuing the offending activity. Ice. Anti-inflammatory medication. Shockwave therapy to promote blood flow and healing.

Rehabilitation and Prevention of Achilles Tendinitis

After a period of rest, usually lasting 5-10 days, gentle stretching and strengthening exercises can be initiated. Heat may be used on the tendon before activity to warm the tendon properly. Adequate warm-up, along with strengthening and stretching exercises for the calves, will help prevent tendinitis of the Achilles tendon.

Long-term Prognosis for Achilles Tendinitis

Tendinitis seldom has lingering effects if treated properly. Tendinitis may take from five days to several weeks to heal, but rarely needs surgery to repair it.

Call (+65) 6471 2674 (24 Hour) to fix an appointment with our orthopaedic specialist to treat Achilles Tendinitis Today.