Achilles tendon rupture

The calf consists of two large muscles: the gastrocnemius muscle and the soleus muscle. Together, these muscles are responsible for movements such as standing on tiptoe and forceful push-offs during running, jumping or sprinting. Both muscles attach to the heel bone via the Achilles tendon, which acts as a connecting link.

Achilles tendon rupture often occurs during sports such as football or sprinting, where explosive force is suddenly required of the calf muscles. It often occurs at the start of a sprint or a powerful push-off, where it feels as if someone has kicked the back of the ankle.

The quality of tendon tissue plays a major role in the occurrence of rupture. When the tendon is weakened by degeneration - a process in which the structure and elasticity of the tissue deteriorate - it is more susceptible to rupture. This can happen due to long-term overuse, previous tendon injuries or natural ageing. When large force is suddenly applied to the tendon when the tissue is already of poorer quality, it can lead to a tear in the Achilles tendon.

• Age: Usually between 30 and 50 years due to decreasing elasticity of the tendon.
• Gender: Men are at higher risk than women.
• Previous injuries: Previous Achilles tendon injuries or a partial tear weaken the tendon.
• Sports: Explosive sports such as football, tennis, basketball and sprinting increase the risk.
• Overload: Building up training intensity too quickly or insufficient warm-up.
• Medical factors: Diabetes, smoking, obesity and use of corticosteroids or certain antibiotics.

Achilles tendon rupture is common in men between the ages of 30 and 40. Tearing of the tendon is usually accompanied by a sharp, sudden pain, often described as feeling as if someone has kicked the back of the ankle.

With a rupture, stretching the ankle is usually painful and, in some cases, it may be impossible to stand on the toes. In more severe ruptures, walking on the affected leg is often not possible. These symptoms usually occur immediately after the time of injury and are often combined with swelling and a visible or palpable thickening in the area of the tendon.

When an Achilles tendon rupture is suspected, the physiotherapist starts with a comprehensive interview to identify the nature of the symptoms, the origin of the injury and any previous injuries. Based on this information, the physiotherapist performs specific tests to confirm whether a rupture is present.

Achilles tendon ruptures can be classified into three grades, depending on the severity:

• Grade 1: A minor injury due to strain of the tendon, with pain and mild swelling often being the main symptoms.
• Grade 2: A partial rupture of the tendon, leading to reduced strength, swelling and more pronounced pain.
• Grade 3: A complete rupture in which the tendon is completely severed. This is often accompanied by an audible "snap", acute pain and loss of function, such as the inability to stand on the toes.

Ultrasound plays a crucial role in the diagnosis of Achilles tendon ruptures at Fysio Fitaal. This safe, painless imaging technique allows the physiotherapist to accurately image the structure of the tendon.

Ultrasound enables:

• Determine the severity of the rupture: Whether it is a minor injury, a partial tear or a complete rupture.
• Visualise inflammation and swelling: This helps distinguish between a rupture and other tendon problems.
• Evaluating the recovery process: During rehabilitation, ultrasound may be used to monitor progress and adjust treatment if necessary.

By combining ultrasound with clinical examination, Fysio Fitaal offers a complete and accurate diagnosis. This forms the basis for a treatment plan fully tailored to the severity of the injury and the patient's personal goals.

Conservative treatment:
In most cases, an Achilles tendon rupture can be treated conservatively. This means that the tendon heals without surgery, often using a special walker (brace) or cast to allow the tendon to heal in a specific position. This approach is supported by exercise therapy, focusing on gradually building strength, mobility and stability. This process is supervised by a physiotherapist and is especially suitable for partial ruptures (grade 1 or 2) and patients with lower loads in daily life.

• Surgical treatment:
  In cases of complete rupture (grade 3) or in patients expecting high functional strain of the tendon, such as athletes, surgery may be necessary. However, this is not always necessary or better with regard to outcomes. During surgery, the tendon is sutured, after which the recovery pathway is supervised by a physiotherapist. This course includes a combination of immobilisation, progressive loading and targeted exercises to strengthen the tendon.

Recovery process

The first week after injury, the body is in the inflammation phase. During this period, it is important to rest and give the body time to recover. This helps to reduce swelling and pain and promote recovery.

After the initial phase, the ankle can slowly be loaded again. In conservative treatment, light movements and progressive loading are usually started within a few weeks, always under the guidance of a physiotherapist. In surgical recovery, a specific protocol after surgery is often used.

Forecast

With proper treatment, the prognosis of an Achilles tendon rupture is generally favourable. Most people make a full recovery and can resume their daily activities and sporting goals. The recovery process takes an average of 12 months after a complete rupture of the Achilles tendon, with or without surgery. This depends only to a limited extent on the severity of the injury and individual circumstances. Early and accurate diagnosis, combined with a targeted treatment plan, is essential to prevent complications and promote optimal recovery.

At Physio Fitaal, we offer a personalised and expert approach to treating Achilles tendon ruptures, guiding you to a full and lasting recovery.