Sep 10, 2020

Achilles Tendon Rupture: Causes, Symptoms & Treatments

We give you the low-down on Achilles tendon ruptures, diagnosis and treatment – and tips on how to prevent it from happening.

Kobe Bryant tore it. David Beckham bust his. George Clooney and Brad Pitt ripped theirs. Judi Dench, Russell Crowe and Dwayne Johnson all ruptured theirs. And for each of them – with all the best physios in the world – the recovery kept them out of their jobs for many months.

physiotherapist during an achilles tendon treatment

The Achilles tendon. Aptly named. It’s quite ironic that Brad Pitt tore his Achilles tendon during the filming of Troy in 2004 – when he was playing Achilles himself.

This blog gives you the low-down on Achilles tendon ruptures, diagnosis and treatment – and tips on how to prevent it from happening.

A word of advice: getting an early diagnosis is always key to improving your chances of non-surgical treatment and quicker recovery.

Any ongoing pain in the back of your lower leg should be examined by a sports medicine professional – correctly diagnosing and treating a weakened or inflamed Achilles tendon can prevent a rupture in the future.

What is an Achilles tendon rupture?

The tendon that attaches your calf muscle to your heel bone (calcaneus) is the largest and strongest tendon in your body – taking more force than any other joint, muscle or tendon.

Your Achilles tendon enables you to move forward from standing, and comes into play when you’re accelerating, changing direction or coming to a halt. Do any of these motions suddenly, and your calf muscle can over-contract, stretching the tendon.

The result can be a rupture – usually at the point there the tendon attaches to the calcaneus. This can be a partial tear, where some of the fibres of the tendon get torn, or a complete tear, where the entire tendon comes away from the heel bone. In some cases, this also causes an avulsion fracture – where pieces of calcaneus bone break away along with the tendon.

What causes an Achilles tendon rupture?

Outside of professional sports, Achilles tendon tears are most common in men over the age of 40. Suddenly accelerating or springing off the ground (such as in football or basketball), serving in tennis or squash, or doing any activity which involves a sharp change in direction can lead to an Achilles tendon tear.

Why does it happen more in older sportspeople? In many cases, there may be wear and tear injuries to the tendon that have occurred over years, making it weaker and stiffer. But also, as we get older, our muscles and tendons are less elastic, making them more liable to tear. It is particularly common in ‘weekend warriors’ – people who are largely sedentary all week and then participate in a high-energy activity at the weekend.

What are Achilles tendon rupture symptoms and signs?

‘I thought someone was behind me and had kicked me,’ David Beckham said of his injury. ‘I looked round, but obviously there was no one there.’ Australian champion Stand Up Paddleboarder, Angela Jackson, was convinced her SUP had smacked her in the back of the calf. Others have described thinking they had been shot in the back of the leg. A tendon rupture is often accompanied by a snapping or popping sound.

The pain is sudden and debilitating, and will probably stop you from walking immediately. It usually dies down to a dull ache, or goes away completely. Your foot may be floppy, and if you can put weight on your foot, your ankle will feel very unstable.

How is a ruptured Achilles tendon diagnosed?

A Thompson Test is a physical assessment – while lying on your front, your doctor squeezes your calf. If your foot doesn’t move as the muscle is compressed, it is likely that the tendon is torn.

An MRI scan will confirm the injury and be used to assess any other damage – such as an avulsion fracture, where your heel bone is broken at the tendon’s point of attachment.

Torn Achilles Tendon Treatment

Most Achilles tendon tears can be managed conservatively.

Normally an ultrasound scan is performed to ensure the ends are opposing each other. If they are not then surgical repair is required. If the tendon has pulled off the heel bone that too will need surgery.

Occasionally if the tendon is very badly damaged it may be necessary to reconstructed using a graft tendon from another part of your body”

Physiotherapy plans are vital to ensure that you build up your muscle strength without putting undue strain on your Achilles tendon.

At Capital Orthopaedics, we also offer blood plasma and steroid injections to stimulate healing.


Dwayne ‘The Rock’ Johnson went back to the gym the day after surgery for Achilles tendon rupture.

He still had to keep the weight off his foot for several weeks while the tendon healed, but he was insistent on training the rest of his body from Day One.

We are not all The Rock, however. It is not advisable to go back to training immediately after an operation – but it is heartening to know that Achilles tendon rupture doesn’t mean you have to lose strength and fitness while you are recovering from surgery or a partial tear.

Recovery times from a ruptured Achilles tendon vary depending on the severity of the tear, but most people return to their peak level of sport within six months.

Preventing an Achilles tendon rupture

Firstly – consult a specialist if you have any ongoing Achilles tenderness or pain. Weakened or inflamed tendons put you at high risk of a rupture.

Here are some other measures you can take to protect your tendon:

  • Stretch your calf muscles regularly – a fitness instructor or physiotherapist can advise you on dynamic stretches that warm and stretch your muscles before activity.
  • Limit hill running and jumping activities.
  • Alternate high-impact sports, such as running, with low-impact sports, such as walking or biking.
  • Rest during exercise if you experience calf or ankle discomfort.
  • Maintain a healthy weight – the heavier you are, the greater the stress on your Achilles tendon.
  • Wear supportive shoes with proper heel cushioning.

Contact an orthopaedic consultant

If you suspect you have ruptured your Achilles tendon, or are looking for a referral, click here for an appointment with our elite sports medicine team in London.

Simon Moyes is an internationally renowned orthopaedic surgeon and leader in the field of arthroscopic (keyhole) surgery.

His Capital Orthopaedics team is made up of highly experienced medical professionals – including consultant orthopaedic surgeons, radiologists, nurses, anaesthetists and physiotherapists.

The Capital Orthopaedics team works from The Cromwell Hospital, Basinghall Clinic and The Platinum Health Centre in London, offering state-of-the-art diagnostic and surgical equipment and top sports medicine professionals.

Contact Simon Moyes for an expert diagnosis and treatment of all your musculoskeletal problems.

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