Achilles Tendon Rupture: Symptoms, Types, Causes and Treatment

Achilles tendon rupture is a significant injury that can affect anyone, from seasoned athletes to people with more sedentary lifestyles. Recognized as one of the most common tendon injuries in the lower extremities, it has become increasingly prevalent in recent decades. Understanding the symptoms, types, causes, and treatments of Achilles tendon rupture is crucial for prompt recognition and optimal recovery.

Symptoms of Achilles Tendon Rupture

When the Achilles tendon ruptures, it often catches people by surprise. The injury can happen during sports, daily activities, or even seemingly minor incidents. Being able to identify the symptoms early can make a meaningful difference in treatment and recovery outcomes.

Symptom	Description	Prevalence/Context	Sources
Sudden pain	Sharp, intense pain at the back of the leg	Most common initial symptom	1 2 5
“Pop” sensation	Audible or felt snap at time of injury	Frequently described by patients	2 10
Weakness	Difficulty pushing off or rising on tiptoes	Common, especially in walking	1 2 5
Swelling	Swelling and bruising in the lower calf	Visible within hours or days	1 2
Palpable gap	Gap in tendon felt above the heel	Detected on examination	1 5
Reduced function	Loss of plantar flexion (downward foot motion)	Marked loss after rupture	1 5

Table 1: Key Symptoms of Achilles Tendon Rupture

Sudden Pain and the “Pop” Sensation

The classic presentation is a sudden, sharp pain in the lower leg, often described as feeling like being kicked or hit. Many patients report hearing or feeling a distinct “pop” or snapping sensation at the moment of injury, which is highly suggestive of tendon rupture. This experience is common in sports but can also occur during simple activities like climbing stairs 1 2 10.

Weakness and Loss of Function

Following the initial pain, people often experience immediate weakness in the affected leg. This weakness makes it difficult to push off the foot, walk uphill, or rise onto tiptoes. Some retain minimal function and can still walk, but with a noticeable limp and reduced strength 1 2 5.

Swelling, Bruising, and Palpable Gap

Swelling and bruising typically appear soon after the injury, centered around the lower calf and just above the heel. On clinical examination, a gap may be palpable in the tendon, usually 2-6 cm above its insertion into the heel bone. Tests such as the Simmonds’ or Thompson test (calf squeeze) can help confirm the diagnosis by showing absence of normal foot movement 1 5.

Types of Achilles Tendon Rupture

Not all Achilles tendon ruptures are the same. Classifying them helps tailor management and predict recovery.

Type	Description	Typical Patient/Scenario	Sources
Acute	Sudden, traumatic rupture	Athletes, "weekend warriors", younger	2 3 5
Chronic	Delayed diagnosis; injury >4 weeks old	Older adults, misdiagnosed injuries	6 11
Complete	Full thickness tear, tendon ends separated	Most common in sports injuries	1 5 8
Partial	Only some fibers torn, tendon continuity	Overuse or gradual degeneration	8

Table 2: Types of Achilles Tendon Rupture

Acute vs. Chronic Ruptures

Acute ruptures occur suddenly and are most frequently seen in athletic or active individuals, especially during activities involving sudden acceleration, jumping, or abrupt changes in direction. These injuries are typically recognized quickly due to the dramatic onset of symptoms 2 3 5.

Chronic ruptures develop when the initial injury is missed or misdiagnosed. Up to 25% of acute ruptures may go unrecognized and become chronic, leading to prolonged disability and more complex treatment. Chronic ruptures often occur in older adults or those with less access to immediate medical care 6 11.

Complete vs. Partial Ruptures

A complete rupture involves the full thickness of the tendon, resulting in a clear gap. Most sporting injuries fall into this category, and the loss of function is profound 1 5 8.

Partial ruptures involve only part of the tendon and may present with less severe symptoms. They often arise from chronic overuse or degenerative changes and may be managed differently than complete ruptures 8.

Causes of Achilles Tendon Rupture

Understanding why Achilles tendon ruptures occur can help with prevention and early intervention. Multiple intrinsic and extrinsic factors contribute to the risk.

Cause	Mechanism/Description	Risk Factors/Contexts	Sources
Sports injury	Sudden forceful loading, jumping, sprinting	Recreational athletes, ball sports	7 9 10
Degeneration	Chronic tendinosis, aging	Middle-aged, decreased blood flow	10 11
Medication	Steroids, fluoroquinolones	Recent medication use	1 2 11
Inactivity	Sedentary lifestyle reduces tendon strength	Older, non-athletic individuals	7 10 11
Overuse	Repetitive microtrauma, overtraining	Runners, older athletes	8
Mechanical	Abnormal foot mechanics (overpronation)	Flat feet, limited ankle mobility	8

Table 3: Common Causes of Achilles Tendon Rupture

Sports and Physical Activity

The majority of Achilles tendon ruptures are linked to sports—especially those requiring sudden acceleration, jumping, or rapid direction changes, like basketball, tennis, and badminton. Middle-aged recreational athletes—the so-called “weekend warriors”—are particularly at risk, as their activity levels may outpace tendon adaptation 7 9 10.

Degenerative Changes and Aging

With age, the Achilles tendon becomes less elastic and more prone to degeneration. Blood flow decreases, collagen fibers stiffen, and the tendon’s ability to withstand sudden stress is diminished. This chronic degeneration sets the stage for rupture, even during less strenuous activities 10 11.

Medications and Systemic Factors

Certain medications, especially systemic or injected corticosteroids and fluoroquinolone antibiotics, are known to weaken tendons and increase rupture risk. Inflammatory conditions and previous tendon problems also predispose individuals to rupture 1 2 11.

Lifestyle and Mechanical Factors

A sedentary lifestyle reduces tendon strength and vascularity, while overuse from repetitive microtrauma or chronic overtraining can cause tendinopathy and microtears. Abnormal foot mechanics, such as overpronation or limited ankle mobility, further increase the risk 8 10 11.

Treatment of Achilles Tendon Rupture

Management of Achilles tendon rupture has evolved considerably, with both operative and nonoperative strategies available. The best treatment depends on patient factors, injury type, and personal goals.

Treatment Type	Key Features	Pros/Cons	Sources
Surgical	Open or percutaneous tendon repair	Lower rerupture rate, higher complications (e.g., infection)	5 13 14 16
Nonoperative	Immobilization (cast/brace), functional rehab	Avoids surgical risks, slightly higher rerupture risk	4 5 13 14
Functional Rehab	Early mobilization with bracing	Improved outcomes, lower complications	4 13 14
Chronic Repair	Tendon grafts, reconstruction techniques	For late-presenting or complex cases	6

Table 4: Main Treatment Approaches

Surgical Treatment

Surgical repair involves suturing the torn tendon ends, either through an open incision or less invasive percutaneous techniques. Surgery is often recommended for young, active individuals or athletes seeking a rapid return to high-function activities. Meta-analyses show a lower rerupture rate for surgical treatment compared to nonoperative management, but the risk of surgical complications—particularly infection, wound problems, and adhesions—is higher 5 13 14 16.

• Open repair: Traditional approach, good visualization, but higher wound complication rates.
• Percutaneous repair: Less invasive, lower risk of infection, but technically demanding 13.

Nonoperative Treatment

Nonoperative (conservative) management typically involves immobilizing the ankle in a cast or functional brace, allowing the tendon to heal naturally. Early mobilization protocols are now favored, as they lead to better functional outcomes and fewer complications than prolonged casting 4 5 13 14.

• Functional bracing: Enables early weight-bearing and movement, reducing risk of stiffness and DVT 13 14.
• Traditional casting: Used less frequently due to higher risk of complications and slower recovery.

Comparing Outcomes

Recent systematic reviews and meta-analyses demonstrate that while surgical repair results in slightly fewer reruptures (2-4% vs. 4-10% for nonoperative care), the absolute difference is small. Functional outcomes, time to return to work, and patient satisfaction are similar when early mobilization is included in nonoperative protocols 14 15 16.

• Surgical treatment is associated with more wound complications (up to 5%) 14.
• Nonoperative care, with modern functional rehab, offers comparable long-term results and may be preferable for older, less active, or higher-risk patients 14 15.

Treatment of Chronic Ruptures

Chronic ruptures, where the injury is diagnosed late, often require more complex reconstruction techniques. Tendon grafts (e.g., peroneus brevis or hamstring autografts) and minimally invasive surgeries are used to bridge the gap and restore function. These cases are more challenging due to tendon retraction and poor tissue quality 6.

Conclusion

Achilles tendon rupture is a common and increasingly frequent injury, especially among active adults and middle-aged recreational athletes. Prompt recognition and tailored management are key to optimal recovery. Here’s a summary of the most important points:

• Symptoms: Sudden pain, a “pop” sensation, weakness, swelling, and difficulty with foot movement are classic signs.
• Types: Ruptures can be acute or chronic, complete or partial, influencing diagnosis and treatment.
• Causes: Most occur during sports, but degenerative changes, medications, inactivity, and mechanical factors all play a role.
• Treatment: Both surgical and nonoperative options are effective; the choice depends on patient goals, activity level, and risk factors. Early functional rehabilitation improves outcomes across treatment types.

Key Takeaways:

• Achilles tendon rupture is best managed with a personalized approach.
• Early diagnosis and active rehabilitation are essential for good recovery.
• Surgical treatment lowers rerupture rates but increases complication risk.
• Nonoperative management with early mobilization is a safe and effective alternative for many patients.
• Chronic injuries require specialized surgical expertise for optimal results.

By understanding the full spectrum of Achilles tendon rupture, individuals and healthcare providers can make informed decisions that promote healing and restore mobility.