The Achilles tendon is the thickest and strongest tendon in the body, located at the back of the ankle. It attaches the two calf muscles (the Gastrocnemius and Soleus) to the heel bone (Calcaneus). Its function is to aid these muscles in plantarflexing the ankle (pointing the foot down or rising onto the tip toes) and to store energy in order to perform this explosive movement as required in sprinting and jumping.

Due to the massive demands on the tendon, it is frequently injured. The most common forms of injury are either tendonitis (tendinopathy) or a rupture of the tendon. These are very different injuries, although if left untreated, a case of tendonitis could result in a rupture as the tendon becomes weaker.

A rupture of the tendon occurs most frequently in males in their 30’s or 40’s; with men being ten times more likely to suffer a complete rupture than women.

With a complete rupture it is usually very clear what has happened. There is a sudden pain in the Achilles, often described as being kicked in the back of the leg, usually associated with a loud popping noise. In many cases pain is not severe as nerve endings are also ruptured, reducing the transmission of pain sensations to the brain. The most obvious symptom after the initial injury is the loss of function. The motion of plantarflexion is severely weakened, with the individual unable to lift the heel off the ground or even push the foot away, against resistance.

When observed by a therapist, it is clear that the tendon is ruptured due to a palpable gap in the tendon and a lack of movement on Thompson’s calf squeeze test.

Partial tears to the tendon are also possible and often cause more pain to the individual than a full rupture. This is due to many nerve endings still being intact. The loss of function with this injury is far less and there may only be a slight limp.

Treatment of a ruptured Achilles tendon can take one of two courses. Either the ankle will be placed in a cast, in a plantarflexed position, to shorten the calf muscle complex and allow healing. This will usually be kept on for approximately 8 weeks, with the plantarflexed position of the ankle being reduced after 4 weeks. A thorough rehabilitation programme should then be followed to restore full range of motion and strength.

The second option is to surgically repair the tendon. After the operation, it has been shown that early mobilisation of the ankle (as opposed to immobilisation in a cast) is likely to reduce complications and promote a faster rehabilitation phase.

Both routes require an extensive rehabilitation programme to regain full flexibility and strength in the Achilles and calf muscles.