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Achilles Tendon Rupture

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The Achilles tendon connects the calf muscle to the heel bone. Ruptures most commonly occur in people aged 30–50, particularly recreational athletes. The tendon typically ruptures when it is rapidly loaded under tension — common mechanisms include accelerating to run in football, pushing off for a tennis shot, or tripping on a curb.

Diagnosis

The diagnosis is primarily made by clinical examination. Ultrasound is not required in most situations.

Treatment Options

Both surgical and non-surgical options provide good outcomes in compliant patients.

Non-surgical treatment is preferred for: diabetics, patients with vascular disease, those with other severe medical problems, low functional demand patients, and where the initial gap is small.

Surgical repair is preferred for: delayed presentations, athletes, and patients without initial treatment within 48 hours (relative indication).

Non-Surgical Treatment

Protected progressive weight-bearing in a boot for 10–12 weeks.

• Advantages: No surgical risk; no significant difference in outcomes at one year
• Disadvantages: Higher re-rupture rate (8–10%); slower initial mobilisation

Surgical Repair

Suture repair of the tendon, performed as a day case.

• Advantages: Lower re-rupture rate (3–4%); possibly better strength; quicker recovery in first 3 months
• Disadvantages: Risk of infection, wound healing issues, nerve injury, and anaesthetic complications

Rehabilitation

• 2 weeks: Foot elevated in cast or VacoPed boot, non weight-bearing
• 2–4 weeks: VacoPed Level 3
• 4–6 weeks: VacoPed Level 2 dynamic
• 6–8 weeks: VacoPed Level 1 — switch to flat foot plate
• 8–12 weeks: VacoPed Level 0 — transition into 10mm gel heel cups after 2 weeks at Level 0
• 12 weeks: Transition into shoes
• Physiotherapy from 2 weeks to regain ankle motion and strength
• 4 months: Returning to recreational walking; beginning to run
• 6 months: Return to sport
• 6–9 months: Swelling resolution
• 12–18 months: Final calf strength result

Time Off Work

• Seated job: 2–3 weeks
• Standing job: 8–10 weeks
• Heavy lifting job: 3–5 months

Driving

• Manual car: 10–12 weeks
• Automatic (left foot): 2 weeks
• Automatic (right foot): 9–10 weeks

When Can I Run?

Once you can perform 10 single heel raises, you can begin more physical activities such as jogging. Do not expect to be jogging before 3 months from surgery.