The Achilles tendon connects the calf to the heel and is prone to rupture when there is a sudden excessive overload on the tendon.
An Achilles tendon rupture is a serious injury involving a tear of the tendon that connects the calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus).
It typically occurs during sudden, forceful movements such as sprinting, jumping, or pushing off the foot - often in sports like football, tennis, or basketball. The injury is more common in men aged 30-50 and may be associated with a sudden increase in activity or underlying tendon degeneration.
Symptoms include a sudden, sharp pain in the back of the ankle or calf, often described as feeling like being kicked or hit, followed by swelling, difficulty walking, and a noticeable weakness in pushing off the foot.
Many people report hearing or feeling a “pop” at the time of injury. In complete ruptures, a gap may be felt in the tendon just above the heel.
Management of an Achilles tendon rupture depends on several factors including the severity of the tear, patient age, activity level, and overall health. Broadly, treatment falls into two categories: conservative (non-surgical) and surgical repair.
Conservative treatment involves initial immobilisation with of the foot and ankle in a plantarflexed (toes pointed downward) position using a cast, walking boot, or splint, followed by physio led functional rehabilitation.
This allows the torn ends of the tendon to come closer together and begin healing naturally. After a period of immobilisation - typically 2 to 4 weeks - patients gradually transition to a more neutral foot position, followed by structured physiotherapy focusing on regaining strength, flexibility, and balance.
This option is more suitable for:
Less active or older individuals
Less severe tears
Patients with medical conditions that increase surgical risk
Those willing to commit to a structured rehab programme
Recent studies have shown that when a proper functional rehabilitation protocol is followed, non-surgical outcomes can be comparable to surgery in terms of re-rupture rates and long-term function — though return to high-level sport may be slower.
Surgery is often recommended for younger, more active patients, athletes, or those who wish to return quickly to high-demand activities. It involves stitching the torn ends of the Achilles tendon together through either an open or minimally invasive technique. The aim is to restore tendon length and tension and reduce the risk of re-rupture. Minimally invasive approaches are increasingly popular due to smaller incisions, lower infection risk, and faster recovery times.
Post-surgery, the foot is usually immobilised in a cast or boot, again in plantarflexion, for about 2–3 weeks. Early controlled weight-bearing and gentle movement are often encouraged under specialist guidance. Physiotherapy begins soon after, progressing through stages of mobility, strength, proprioception, and eventually sport-specific training. Full recovery can take 6-12 months, depending on the level of pre-injury activity and the individual’s rehab progress.
Ultimately, both treatment options can result in good outcomes, but success heavily relies on a well-structured rehabilitation programme and patient adherence to recovery protocols.
We always ensure a shared decision-making process, to determine the most appropriate route for each individual.
