What you need to know about Achilles tendon ruptures: a Q&A with physiotherapist Tom Stukins

Tom Stukins has been a physiotherapist at Body Logic Physiotherapy since 2015 and is also an avid tennis player and cyclist. In 2022, he experienced an Achilles tendon rupture while playing squash. 

With his personal experience as a patient and his professional expertise as a physiotherapist, in this Q&A Tom covers everything you need to know about Achilles tendon ruptures.

If you’ve experienced an Achilles tendon rupture, our experienced team can help you on the road back to recovery following your sports injury in Twickenham through targeted physiotherapy. 

What is the Achilles tendon and when do we use it?

The Achilles tendon is the biggest tendon in your body. It is attached to the calf muscles in the back of your leg, specifically your gastrocnemius and soleus muscles, and the heel bone in your foot. 

Of all the tendons in your body, it carries the most load and force, especially when you’re engaged in explosive movements, such as running, jumping and sprinting. It’s one of the main propulsion mechanisms for these movements. 

What are the risk factors for rupturing your Achilles tendon?

The main risk factors are the type of activities you participate in, your general strength and fitness levels and age. As you get older, all of your tendons become ‘less elastic and more plastic’. This means they become less compliant, lose their ‘robustness’ and become more likely to be injured. 

Achilles tendon ruptures are, therefore, most common in the over 40s. In those under 40, it usually occurs in elite athletes.

After the lockdowns of 2020, as a physiotherapist, I saw a spike in Achilles tendon ruptures as many people were less active for a prolonged period of time, which weakened their muscles and consequently ‘deconditioned’ their tendons. This is because the structure and function of your tendons is directly dependent on the strength of your muscles — weakened muscles cause a drop in the levels of collagen in your tendons, making them structurally less resiliant. 

When people returned to physical activity, post-lockdown, with their tendons no longer conditioned to explosive movements, many more experienced Achilles tendon ruptures. That’s exactly what happened to me at the end of 2022, when I returned to playing squash and 20 minutes into a game, ruptured my Achilles tendon.

What should you do immediately after rupturing your Achilles tendon?

An Achilles tendon rupture usually occurs during an explosive movement. The moment it ruptures, you will in  most cases fall to the floor. You will feel your tendon ‘go’ but may not feel much pain. In the first instance do not be tempted to get up and try to walk it off. 

In most cases, an Achilles tendon rupture is complete, which means you are left with two loose ends. These ends need to stay as close to each other as possible to allow your body to create bridges of scar tissue that will reconnect your Achilles tendon and promote healing. Ideally, the two ends should stay within half a centimetre of each other; the further apart they move, the more likely you are to need surgery. 

To avoid the two ends of your ruptured Achilles tendon pulling further apart, do not walk on your injured ankle and keep your toes pointed. Instead, hop on your good leg and go to your nearest A&E. 

How is a ruptured Achilles tendon treated?

At A&E, if they suspect a rupture, they will apply a plaster of paris front slab to your foot — this is a plaster slab placed on the front of your foot and secured in place with bandages to ensure your toes stay pointed. You will also be given crutches as you won’t be able to bear weight on your injured foot.  

Then, you will be referred for an ultrasound scan to measure the distance between the two ruptured ends of your Achilles tendon. This will allow your doctor to determine whether or not you need surgery. 

What does non-surgical treatment involve? 

If you don’t need surgery, after the swelling around your ankle has subsided, which usually takes 2–5 days, your foot will be placed into a full plaster cast with your toes pointed. After two weeks, your plaster cast will be removed and you will be fitted with a VACOped boot — a special boot which can protect the Achilles tendon as it heals but can also be set at different angles to slowly allow the functional length to be recovered. 

Your toes will be kept pointed but every two weeks, you will change the angle at which your foot sits within the boot. This is essential to regain the functional length of your tendon. If you don’t do this, the scar tissue that develops will become too tight, leaving your Achilles tendon too short to function as normal. 

You will need to wear your VACOped boot for three months. 

What does surgery to repair a ruptured Achilles tendon involve? 

To repair an Achilles tendon rupture, your surgeon will make a small cut along the back of your ankle. The two torn ends of your Achilles tendon will be sewn together using strong, dissolvable sutures (stitches), creating an overlap between the two ends of the tendon. Growth factors (hormones) are sometimes injected into the site to help healing. 

Your foot will then be placed in a full plaster cast for two weeks, after which you will need to wear a VACOped boot for three months. 

Do I need physiotherapy during my recovery? 

Yes, whether your rupture is treated surgically or not, you will always need physiotherapy to regain the strength, function and range of movement of your Achilles tendon. 

You will start physiotherapy four weeks into your treatment i.e. after you have been using your VACOped boot for around two weeks. During your physiotherapy exercises, you will need to remove your boot. 

Gentle manipulations will be used to keep your scar tissue supple and help your tendon heal. You will also begin practising basic movements of your toes and ankle, as well as exercises to preserve the strength of your other joints and muscles i.e. your knee, hip, quadriceps, hamstrings and buttocks. Hydrotherapy is a great way to keep these muscles and joints strong during your recovery without placing them under too much strain. 

Once you are 6–9 weeks into your recovery, your physiotherapist will recommend that you start exercises to strengthen your Achilles tendon and calf muscles.

When will I be fully recovered and what will it take to get there?

Around three months into your recovery, you will be able to move around without wearing your VACOped boot. Even with your daily physiotherapy exercises, your calf muscles will still be much weaker than before your Achilles tendon rupture. 

You will, therefore, walk with a limp and still need physiotherapy for up to nine months after your injury. Your physiotherapist may recommend muscle stimulators to help restore your natural walking pattern (gait). 

From three months post-injury, there will be an increasing focus on building back the functional strength of your Achilles tendon and surrounding muscles, with a variety of calf-raising exercises. You will also need to strengthen your glutes, hamstrings and quadriceps. 

As your strength increases, you will progress to more active exercises, such as hopping, skipping and running at increasing speeds. A personal trainer can help with a programme of strength and conditioning exercises. 

It will take 6–12 months before you’re able to return to your usual sporting activities. In general, elite athletes recover faster while most others will need the full year — I certainly did. 

Following my recovery, will I be at greater risk of a future Achilles tendon rupture?

Yes,  your Achilles tendon will be at greater risk of a rupture but not as much as you may think. If your recovery was non-surgical, your risk of re-rupture is 4%. If your recovery involves surgery, your risk of re-rupture is 2%.

Although the risk of re-rupture following a surgical recovery is lower, surgery comes with its own risks e.g. infection, nerve damage and/or damage to other tissues. This is why, wherever possible, a non-surgical recovery is preferable. 

If you’ve sustained an Achilles tendon rupture or any other sports injury in Twickenham and are looking for expert physiotherapy to get you back to your usual activities as quickly as possible, please do get in touch.