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Achilles Tendon Rupture

Achilles Tendon Rupture

Achilles tendon is a strong fibrous cord present behind the ankle that connects the calf muscles to heel bone. It is used when you walk, run and jump. When the Achilles tendon becomes thin, weak, or if it is not used, it may be susceptible to injury or damage. Achilles tendon rupture occurs most often in middle-aged athlete participating in sports that involve running, pivoting, and jumping. Recreational sports that may cause Achilles rupture include tennis, racquetball, basketball, and badminton.

If Achilles tendon is ruptured you will experience severe pain in the back of your leg, swelling, stiffness, and difficulty to stand on tiptoe and push the leg when walking. A popping or snapping sound is heard when the injury occurs. You may also feel a gap or depression in the tendon, just above heel bone.

Your doctor diagnoses the rupture based on symptoms, history of the injury and physical examination. Your doctor will gently squeeze the calf muscles, if the Achilles tendon is intact, there will be flexion movement of the foot, if it is ruptured, there will be no movement observed.

Achilles tendon rupture is treated using non surgical method or surgical method. Non surgical treatment involves wearing a cast or special brace which is changed after some period of time to bring the tendon back to its normal length. Along with cast or brace, physical therapy may be recommended to improve the strength and flexibility of leg muscles and Achilles tendon. Surgical procedure involves opening the skin and suturing the torn tendon together. Surgery helps to decrease the recurrence of the Achilles tendon in comparison to the non-surgical treatment.

To help prevent an Achilles tendon injury, it is a good practice to perform stretching and warm-up exercises before any participating in any activities. Gradually increase the intensity and length of time of activity. Muscle conditioning may help to strengthen the muscles in the body.


Please give a copy of this letter to your physiotherapist when you next see them before you start any treatment.  You have had an Achilles tendon operation necessitating immobilisation.  The treatment regime for this is broken down into three equal four-weekly stages.  The treatment regime will be outlined as below: You will need to take 150 to 300mg of aspirin per day whilst in your cast but it would be sensible to take this for the full 3 months assuming no side-effects

0-2      Posterior slab/splint; non-weight-bearing with crutches: immediate postop. in surgical group, after injury in nonop. group
2-4      Moonboot/Aircast walking boot with 2-cm heel lift*†
           Protected weight-bearing with crutches
           Active plantar flexion and dorsiflexion to neutral, inversion/eversion below neutral
           Modalities to control swelling
           Incision mobilization modalities‡
           Knee/hip exercises with no ankle involvement; e.g., leg lifts from sitting, prone, or side-lying position
           Non-weight-bearing fitness/cardiovascular exercises; e.g., bicycling with one leg, deep-water running
           Hydrotherapy (within motion and weight-bearing limitations)
4-6      Weight-bearing as tolerated*†
           Continue 2-4 week protocol
6-8      Remove heel lift
          Weight-bearing as tolerated*†
          Dorsiflexion stretching, slowly
          Graduated resistance exercises (open and closed kinetic chain as well as functional activities)
          Proprioceptive and gait retraining
          Modalities including ice, heat, and ultrasound, as indicated
          Incision mobilization‡
          Fitness/cardiovascular exercises to include weight-bearing as tolerated; e.g., bicycling, elliptical machine, walking and/or jogging on treadmill,
8-12    Wean off boot
          Return to crutches and/or cane as necessary and gradually wean off
          Continue to progress range of motion, strength, proprioception
>12    Continue to progress range of motion, strength, proprioception
          Retrain strength, power, endurance
          Increase dynamic weight-bearing exercise, include plyometric training
          Sport-specific retraining

*Patients can remove the boot in bed at night
†Patients could remove the boot for bathing and dressing but were required to adhere to the weight-bearing restrictions according to the rehabilitation protocol. ‡If, in the opinion of the physical therapist, scar mobilization was indicated (i.e., the scar was tight or not moving well), the physical therapist would attempt to mobilize using friction, ultrasound, or stretching (if appropriate). In many cases, heat was applied before beginning mobilization techniques.

If there are any problems with this range of motion rehabilitation treatment plan I would be grateful if your physiotherapist could contact me.

As stated this letter should be given to your physiotherapist to allow a consistent and accurate treatment plan to be instituted for your Achilles tendon surgery.

Thank you. Please don't hesitate to contact if you are in any doubt or wish to discuss this case


Peter Black
Consultant Orthopaedic Surgeon
MCNZ 38925
ACC AA9984

PO Box 11084, Hillcrest, Hamilton

Tel: 079576094  Fax: 079576093 Email:
Mr. Peter RM Black - Anglesea Clinic Orthopaedics Mr. Peter RM Black - Anglesea Clinic Orthopaedics
BSc (Hons), MBBCh,
FRCSEd, FRCS (Tr & Orth)
Orthopaedic Surgeon
Mr. Peter RM Black - Anglesea Clinic Orthopaedics
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