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Achilles Tendon Rupture

Background & Etiology (Cause)

The ankle region contains two joints, the ankle joint and the subtalar joint. These joints must be strong because they support the weight of the entire body while enabling us to run, walk, and jump with precision and flexibility. Tendons are connective tissues that attach muscle to bone. They are strong, fibrous structures that are responsible for transferring the forces generated by the muscle to the bone, thus producing movement at the joint. When a tendon becomes irritated or inflamed it becomes painful, causing tendonitis. The tendons in the ankle region are subject to significant stress, and can rupture under extreme pressure.

Tendon Rupture

When a tendon ruptures it can be extremely painful and cause a disability of the foot that then subsequently causes damage to the ankle joints. The tendons in the ankle include: the peroneals (peroneus brevis, peroneus longus,) anterior tibialis, posterior tibialis, and Achilles tendon. Any of these structures can become ruptured, which is a serious condition that will typically require surgery to fix.

Achilles Tendon

The Achilles tendon is one of the most vulnerable tendons in the body because while tendons are strong, they can only be stretched so far before they tear or rupture and the Achilles is typically subject to a significant amount of stress. The Achilles tendon attaches the gastrocnemius (calf) muscles and the soleus muscles in the lower leg to the heel of the foot. The movement of these muscles is crucial for proper function of the foot, ankle, and even the knee. When the Achilles tendon is injured it can cause a serious dysfunction of these structures.


Common causes of an Achilles tendon rupture include

  • The progression of or the final result of longstanding Achilles tendonitis or an overuse injury.
  • An injury to the ankle or a direct blow to the Achilles tendon.
  • Laceration of the tendon
  • Steroid use has been linked to tendon weakness
  • Certain systemic diseases have been associated with tendon weakness.
  • A sudden deceleration or stopping motions that cause an acute traumatic injury of the ankle.
Symptoms of Achilles Tendon Ruptures
  • Ankle pain and swelling or feeling like the ankle has “given out” after falling or stumbling.
  • A loud audible pop when the ankle is injured.
  • Swelling, tenderness and possible discoloration or ecchymosis in the Achilles tendon region.
  • Difficulty moving around or walking.
  • ndividual has difficulty or is unable to move their ankle with full range of motion.
  • MRI can confirm disruption or tear in the tendon.
  • Inability to lift the toes.
Treatment of Achilles Tendon Rupture

Early diagnosis and treatment is the key to a successful outcome for an Achilles tendon rupture. If diagnosis or treatment is delayed the integrity of the healing tissue can be compromised as a result of scarring and decreased blood flow. Surgical repair followed by structured and aggressive physical therapy is the treatment of choice for complete ruptures. In the case of a small partial tendon tear conservative treatment without surgery is an option.

Partial (small) Achilles Tendon Tear
Treatment of Complete Achilles Tendon Ruptures
  • The surgeon will determine the physical therapy timeline and program.
Physical Therapy Interventions

Common Physical Therapy interventions in the treatment of Achilles Tendon Rupture include:

  • Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion and strengthen the gastrocnemius and soleus muscles of the ankle and lower extremity.

If repair and treatment are initiated immediately, individuals with a rupture or tear the Achilles tendon generally do well. Delay can result in the formation of scar tissue and retraction of the tendons. Other factors that can affect recovery are:

