The terms Achilles tendon tear and Achilles tendon rupture are often used synonymously on the Internet, however, not by experts. We always take an Achilles tendon tear to be a complete tear – or Achilles tendon rupture in medical jargon – and use the term partial Achilles tendon tear separately.

However, an Achilles tendon tear is not as common as degeneration of the Achilles tendon. But, from time to time, parts of the Achilles tendon or even the whole tendon may tear.

1. What causes an Achilles tendon tear?
2. How do I recognize an Achilles tendon tear?
3. What should I do if I have a suspected Achilles tendon tear?
4. Diagnosing an Achilles tendon tear
5. Treating an Achilles tendon tear

Here you will find out how you can recognize an Achilles tendon tear and what do you have to.

1. What causes a complete or partial Achilles tendon tear?

• Under load, just one part of the Achilles tendon is usually affected. However, if that part of the tendon is subject to excessive loading time and again, it may tear.
• Normal loads lengthen the Achilles tendon by approx. 4%. If the tendon is stretched by more than 4%, micro-tears appear.
• If the tendon is stretched by 8–12%, it tears completely.

2. How do I recognize an Achilles tendon tear?

Those who are affected by this often hear a sudden snapping noise, like the crack of a whip.

• This is accompanied by a sharp pain. The area then swells up.
• A haematoma (bruise) forms.
• It is impossible to stand on tiptoe.
• A gap can be felt in the Achilles tendon.

The good thing about this is that it tells you that something is wrong and so you can go and see a doctor.

An Achilles tendon tear can be seen and felt immediately as you will not be able to walk on it and the continuity of the tendon has been broken.

Many partial tears of the Achilles tendon are not felt or seen so clearly. Your doctor will not immediately detect a partial tear either. This means that a partial Achilles tendon tear can remain undetected for some time. Only after several weeks and restricted movement accompanied by pain, will a further examination be carried out and a clear diagnosis made. A partial tear can only be diagnosed using imaging procedures (ultrasound, MRI).

3. What should I do if I suspect an Achilles tendon tear?

It is always best to: go straight to the doctor for an accurate diagnosis and to immediately undergo suitable treatment, e.g. a surgery.

4. Diagnosing an Achilles tendon tear:

• extensive medical history – gathering all the relevant medical information
• physical examination – there are other examination methods apart from palpation
• possible ultrasound examination
• if unclear, an MRI is performed (Magnetic Resonance Imaging)

• rupture, partial rupture or two or more stage rupture
• at the start/base of the heel bone: 0–2 cm above this point
• in the middle of the tendon: 2–8 cm above the base of the tendon
• near the transition between the tendon and the calf muscle: > 8 cm above the base of the tendon.

Complete Achilles tendon tears are not very common. In most cases, there is a partial tear in the Achilles tendon. Under load, the whole Achilles tendon is not normally affected. Often, only individual bundles of fibers are affected, which of course cannot withstand as much strain as the whole Achilles tendon.

A partial Achilles tendon tear can be fixed by surgery, but is often treated conservatively. The doctor will assess how much of the Achilles tendon is torn and will then decide on the treatment.

5. Treating an Achilles tendon tear:

There are basically two measures: surgery or conservative treatment without surgery. We will briefly explain both forms of treatment below.

Here, there are two techniques for surgery: one involving a small incision in the skin and another involving a larger one. In both cases, rehabilitation in the style of 'early functional rehabilitation' is quite important: here, the foot is not immobilized as used to be the case, but is moved from time to time from the very beginning. Your participation in this process is crucial in the healing process. Your doctor and physiotherapist will take good care of you and will also show you exercises that you can and should do at home. These include strength exercises – eccentric strength training is normally recommended, however, this is not advised until later on in the healing process.

Fitness for sport: in the case of the 'mini-skin-incision method', you will be fit for sport again in approx. five months*; in the case of the open technique with a larger incision it will take another month. But: in any case seek advice from your surgeon regarding which is the best technique in your particular case.

Also, in the case of 'conservative' treatment of a partial Achilles tendon tear, that is, without surgery, the torn ends of the Achilles tendon can grow back together. It is important here that the procedure results in the tendon being the same length as before. Otherwise, the Achilles tendon will not have the same elastic and functional characteristics.

Normally, in the early days following a partial Achilles tendon tear, a special shoe is prescribed in which the patient stands or walks with their foot in an equines position. The advantage of this method is that the patient is mobile again from the beginning – although movement is limited – and does not have to stay in hospital. Following this 'shoe therapy', further treatment is like that after a surgery.

Sporting activities may be resumed after approx. six months*.

*Please note: the time required to return to full-weight-bearing activity within the scope of Achilles tendon treatment is difficult to define as it depends on several factors:

• in the event of a surgery, it depends on the surgeon and their technique;
• depending on the healing process, the results are different in each case and also depend on the methods used;
• in the case of sporting activities with predominantly cyclical movements, such as jogging, the process is faster (the above-mentioned four to five months); in the case of sports involving high loads, such as jumping and all sports with rapid changes of direction and sudden stops and acceleration, it normally takes longer.

Conclusion: discuss with your therapist when it will be possible to resume full-weight-bearing activity!

You should discuss this with your doctor. They know what is best in YOUR PARTICULAR CASE. Generally spoken, the following criteria can be used:

• what is the exact diagnosis (type of Achilles tendon tear and location)?
• how high is the risk of wound healing disorders or the risk of infection? If the risks are high, conservative treatment is better
• are you a competing or professional athlete? If so, surgery is preferable

In any case, consistent, early functional rehabilitation must take place, that is, the patient should be back on their feet as soon as possible and movement and strain appropriate for the healing process gradually intensified.