An Achilles tendon rupture is a complete or partial tear of the largest tendon in the body, the cord-like structure connecting the calf muscles to the heel bone. The injury typically occurs from sudden push-off or eccentric loading during sport, produces immediate pain and inability to push off normally, and requires timely treatment. Dr. Chudik treats Achilles ruptures with both surgical and non-surgical protocols based on the patient’s age, activity level, and tear pattern.
What Is an Achilles Tendon Rupture?
The Achilles tendon attaches the gastrocnemius and soleus muscles of the calf to the calcaneus (heel bone). The tendon transmits the force of plantarflexion (pointing the foot down) during walking, running, and jumping. Achilles ruptures most commonly occur in the watershed area approximately 2 to 6 cm above the heel insertion, where the blood supply is poorest.
Most ruptures are complete, producing total disconnection of the calf muscles from the heel. Partial tears are less common and typically involve the deep tendon fibers.
Causes and Risk Factors
- Sudden push-off in a recreational athlete, often described as feeling like being kicked in the back of the calf
- Eccentric loading during sport (basketball, tennis, weekend recreational sports)
- Age 30 to 50 is the most common demographic
- Male sex
- Prior Achilles tendinosis
- Fluoroquinolone antibiotic use, which is associated with tendon rupture
- Local corticosteroid injection into the tendon
- Diabetes and chronic kidney disease
Symptoms
- Sudden severe pain in the back of the lower leg
- Audible or felt pop at the time of injury
- Inability to push off normally with the affected leg
- Visible defect in the tendon that can sometimes be palpated
- Bruising and swelling that develops over hours to days
- Positive Thompson test on examination (squeezing the calf does not produce normal foot plantarflexion)
Diagnosis
Dr. Chudik’s evaluation includes the mechanism, timing, and a focused examination. Loss of plantarflexion strength and a positive Thompson test are diagnostic. MRI confirms the diagnosis, characterizes the tear (complete versus partial, location, retraction), and is helpful when planning surgical timing. Ultrasound is also useful for tear assessment. The Westmont office has on-site high-field MRI.
Treatment
Both surgical and non-surgical treatment options are available, with the choice influenced by patient factors:
Non-surgical treatment with functional bracing has shown good outcomes in recent studies, particularly with early functional rehabilitation protocols. It involves an equinus boot for several weeks with progressive heel lift reduction, followed by physical therapy and gradual loading.
Surgical repair is considered for younger active patients, athletes who require maximum push-off strength, and patients with chronic tears or those who present with retracted tendon ends. Dr. Chudik performs Achilles tendon repair through a small incision, reattaching the torn tendon ends with locking sutures.
Recovery and Outcomes
Recovery from non-surgical treatment typically requires 8 to 12 weeks in a boot with progressive heel lift reduction, followed by progressive loading and strengthening over three to six months. Return to sport is typically four to six months.
Recovery from surgical repair typically includes six to eight weeks in a boot with progressive heel lift reduction, similar progressive loading, and return to sport at four to six months.
Outcomes are good with both protocols when the rehabilitation is completed. Recent literature shows comparable functional outcomes between non-surgical and surgical treatment with early functional rehabilitation, though individual factors guide the choice.
When to See Dr. Chudik
Schedule urgent evaluation if you have sudden severe pain in the back of the lower leg with inability to push off, particularly during sport. Time matters. Call 630-324-0402 or request an appointment online.