Achilles Rupture

Patient Information

An Achilles tendon rupture is a serious sports injury involving a complete or partial tear of the Achilles tendon — the largest tendon in the body, connecting the calf muscles to the heel bone. It is most commonly seen in recreational athletes (the so-called “weekend warrior”) and requires prompt diagnosis and management. Mr Matthew Welck is a specialist foot and ankle surgeon in London offering expert treatment for Achilles tendon rupture at the RNOH Stanmore, The Wellington Hospital North London, and Spire Bushey Hospital.

Useful patient resource: Mayo Clinic – Achilles Tendon Rupture

What is an Achilles Tendon Rupture?

The Achilles tendon is the thick, fibrous band connecting the gastrocnemius and soleus muscles of the calf to the calcaneus (heel bone). It is essential for walking, running, jumping, and climbing stairs. An Achilles rupture occurs when excessive sudden force is applied to the tendon, most commonly during ballistic activities, a change in speed, or a sudden unexpected loading of the tendon.

The spectrum of injury ranges from minor muscle strain to partial tears and complete full-thickness ruptures. Complete ruptures — which account for the majority of cases requiring specialist referral — often present dramatically with the patient describing a sensation of being struck in the back of the leg.

Common Causes and Risk Factors

• Sudden forceful push-off or acceleration, e.g., sprinting, jumping, or pivoting in racquet sports, football, or basketball
• Tripping and falling, particularly in older recreational athletes
• Pre-existing Achilles tendinopathy (degeneration) weakens the tendon and increases rupture risk
• Use of corticosteroids (systemic or local injection) and certain antibiotics (fluoroquinolones) are associated with increased risk
• Increased age (most common in men aged 30–50)
• Sudden increase in training load or return to sport after a period of inactivity

Symptoms

• Sudden severe pain in the back of the ankle or lower leg, often described as a “pop” or “snap”
• Immediate difficulty or inability to push off the foot or stand on tiptoe
• Swelling and bruising around the back of the ankle
• A palpable gap may be felt in the tendon above the heel
• Altered resting position of the foot (more dorsiflexed than the opposite side when lying prone)

GP Information

Clinical Diagnosis – Simmonds’ Triad

Clinical examination using Simmonds’ triad is highly accurate for diagnosing a complete Achilles rupture and should be performed in all suspected cases:

• Altered angle of declination – When the patient lies prone, the foot of the injured leg rests in a more dorsiflexed (upward-pointing) position compared to the uninjured side
• Palpable gap – A defect can be felt in the tendon, typically 2–6 cm above the heel
• Positive calf squeeze test (Thompson/Simmonds test) – Squeezing the calf with the patient prone fails to produce the normal plantarflexion (downward movement) of the foot

Investigation Guidelines

• Ultrasound (USS) may be used to localise and grade pathology, confirm rupture, and assess the gap size. This typically follows specialist assessment.
• MRI is occasionally used for complex cases or diagnostic uncertainty.

Referral Guidelines

Suspected acute Achilles tendon rupture (complete or partial) requires immediate referral to the Emergency Department. The patient should be placed in an equinus boot (foot pointing down) and kept non-weight-bearing pending specialist assessment. Prompt referral within 1–2 weeks of injury is important as early treatment — either surgical or functional rehabilitation — achieves the best outcomes.

For calf muscle strain (without rupture), initial management should include:

• PRICE and avoidance of HARM for 72 hours following injury
• Analgesia – paracetamol or topical NSAID; consider short-course oral NSAIDs for 48 hours post-injury
• Active mobilisation after a few days once basic pain-free movement is possible
• Eccentric stretching and strengthening exercises once pain-free
• Physiotherapy referral for athletes or patients who fail to respond to conservative management

Surgical vs Non-Surgical Treatment

Both operative and non-operative (functional rehabilitation with an equinus boot) treatment protocols are well-established for complete Achilles ruptures. Mr Matthew Welck discusses the evidence-based options with each patient, taking into account age, activity level, compliance with rehabilitation, and patient preference. Young and active patients often benefit from surgical repair to reduce re-rupture risk and facilitate earlier return to sport. Non-operative treatment with an accelerated rehabilitation protocol achieves comparable outcomes in many patients and avoids the risks associated with surgery.

Book a Consultation in London

For expert assessment and treatment of Achilles tendon rupture in London and North London, please contact Mr Matthew Welck’s clinic to arrange a prompt consultation.