Achilles Tendon Rupture: Cause, Symptoms & Treatments

I once suffered an Achilles Tendon Rupture myself.

Luckily, I am a physiotherapist.

I want you to succeed too.

As an experienced physical therapist and patient who has overcome an Achilles tendon rupture, I recommend you read this article as a first step before delving into the decisions you will have to make to recover in the best possible way.

Here you will find direct information from someone who experienced it in the first person and who understood that professional support is often lacking during the course of your recovery.

I am going to show you in the following index each of the topics explained, in order to give you a general idea of what you will have learned at the end of this article.

Besides, towards the end, you will have the link to the ebook that has just been published in English, so that you can complement your rehabilitation, whatever the moment of recovery you are

“Improve Your Achilles Tendon Rupture” is my little treasure of 241 pages, only for patients.

And I promise you will see yourself reflected in it many times.

INDEX

1. Signs and symptoms.

2. Diagnosis.

3. Causes of tendon rupture.

4. Can I walk with a torn Achilles tendon?

5. Achilles Rupture treatment.

6. Achilles tendon surgery.

7. How long does it take to recover from a ruptured Achilles tendon?

8. Achilles tendon rupture rehabilitation.

9. Sequels.

10. Partial rupture of the Achilles tendon.

11. Ebook for patients “Improve your Achilles tendon rupture”.

1. Signs and symptoms.

In this first point you will understand what the signs and symptoms are during and after the rupture of the Achilles tendon.

You will be able to better decide if your injury should be evaluated by a specialist in case you have not already done so.

You will also learn about the signs and symptoms to expect after tendon repair surgery.

1.1 Symptoms prior to rupture

In many cases, patients report not having felt symptoms prior to the rupture of the Achilles tendon, and if they have, scientific evidence indicates that in 95% of cases the pain existed in the opposite leg.

So, we could talk about a warning sign but from the opposite leg. Still, there is no data and no imaging tests to predict if an Achilles tendon will rupture in the future.

In short, you probably didn’t feel anything in the times leading up to the breakup.

1.2 What does torn Achilles feel like?

Characteristic noise.

The sound during the break, if it occurs, is usually very different from the other clicks you may feel in other injuries or at least compared to the normal joint sounds of the body.

Stone sign.

Another characteristic is the feeling that someone has thrown a stone at you, or that you have been kicked or stepped on from behind.

Pain.

It may exist or not, depending on the involvement of the nervous system at the time of the injury. It tends to describe quite tolerable pain in most cases.

However, if there is involvement of the sural nerve or any of its branches, the pain may be significant.

Functional impotence.

If there is a complete rupture of the Achilles tendon or at least a significant percentage, you will have partial or total inability to perform plantar flexion of the foot.

Some patients with a partial tear describe that they can walk but with difficulty.

I will explain to you in point 4 if it is allowed to walk with a partial tear or not.

1.3 Signs and symptoms after Achilles tendon rupture

Inflammation.

Following an injury event, an inflammatory response is triggered to repair damaged tissue.

Hack sign.

In some cases, you can feel or see the sinking of the skin, where the tendon has been damaged.

Hematoma.

If there has been a rupture of vessels (veins and/or arteries) or blood capillaries, an effusion can be expected that can appear even a few days after the injury, sometimes covering the heel, ankle and foot area.

Alteration of sensitivity.

The loss of tactile sensitivity can occur due to the inflammation itself, compression of the nervous system or the injury of a peripheral nerve.

In this case, you should mention it to your reference therapist to take measures if necessary.

Nerve injury.

It may occur after the injury that one of the peripheral nerves is affected and that there are painful signs due to this cause, as well as altered sensitivity, tingling, or the inability to perform a movement due to the injury of a motor nerve.

1.4 Signs and symptoms after surgery

Pain.

Is achilles tendon surgery painful? As many other surgeries.

Pain is the most characteristic symptom after any surgery, so it can exist, although it should be always controllable.

If it is not achieved with the prescribed medications, the specialist can escalate to more powerful ones. In that case, the cause of that intense pain should also be determined, to prevent other added complications.

Inflammation.

As I explained to you before, inflammation is a natural process that appears to try to repair damaged tissue. Surgery causes controlled tissue damage and is expected to provoke a subsequent inflammatory response.

The expectation is that it is controllable with medication and even after a few days, that does not represent inconveniences or the need to resort to medication.

It may be around for a while, especially until you start moving your injured leg and foot.

I explain how to reduce both inflammation and oedema in chapter 7 of the book.

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Hematoma.

Hematoma is another of the probable signs that you will find after surgery, so you do not have to worry about it.

It can cover from the periphery of the scar to a good part of the foot region, but it should gradually decrease and spread.

If this effusion causes loss of sensitivity or other alterations such as pain, heaviness, tingling (paresthesia), etc., it is important to be evaluated by your reference therapist or doctor.

Achilles tendon rupture image of bruised ruptured ankle

1.5 How to manage your symptoms.

At this point, you already have a more global idea of the most frequent signs and symptoms after an Achilles tendon rupture.

Remember that most of the signs and symptoms described above can usually appear after the injury or surgery, and whenever any of them represents a significant inconvenience, you have to let your reference specialist know.

Pain, inflammation and hematoma are components that must be easily controlled with physical, mechanical or pharmacological measures. If not, turn to your therapist in charge.

The alteration of sensitivity and functional impotence (not being able to move a part of the body) must be told to your doctor or physiotherapist so that they can evaluate and take the measures they deem appropriate.

In addition, throughout the course of my book “Improve your Achilles Tendon Rupture”, you will have tools aimed at managing this type of symptoms so that nothing is left to chance.

You will see that this article does not represent even 10 per cent of what you will find in the book, more than 200 pages of information and how to carry out your rehabilitation in a planned and orderly manner.

However, now it is time to continue reading the second point, which talks about how this injury is diagnosed.

2. Diagnosis of Achilles tendon rupture

2.1 How to know if I ruptured my Achilles tendon

You will understand what symptoms make us think of a possible diagnosis of Achilles tendon injury, in addition to the manual and imaging tests that are carried out to confirm it.

2.2 Signs and Symptoms prior to diagnosis

During this point, you will see what signs at the time of injury suggest a possible diagnosis of Achilles tendon tear, before moving on to orthopedic tests and imaging tests.

Some of them are the following.

Injurious noise.

The sound that can be perceived at the right moment of the injury is not comparable to other types of structure ruptures, since a strong snap can be felt right in the area of the injury.

When I tore my Achilles tendon, the first thing I thought when I heard that noise was in this injury almost instantly.

Stone sign

The feeling that a stone has fallen on that area or that someone has stepped on you from behind is also a sign of Achilles tendon rupture.

When you turn around and realize that there is nothing and nobody behind, you can suspect what type of injury it is.

Pain.

The pain, if it appears, is very variable. If the nerve is not affected, it will be located in the area of the injury and will not have a wide extension, but rather a very focused one.

If the nerve is damaged, it can even hurt in the foot.

Functional impotence

If there is a complete rupture of the Achilles tendon or at least a high percentage, another important sign will be the lack of activation of the muscles that perform plantar flexion of the foot.

In many cases, this plantar flexion is compensated with other flexor muscles that do similar movements, so you could doubt whether you have this sort of injury or not and wonder if you may walk or not.

2.3 Exploration

During the medical examination, some signs are usually found that determine a possible confirmation of this diagnosis.

Below, I detail the most relevant ones.

Hack sign

In the palpatory examination, a small space or hole may appear that can be seen when palpating just in the area of the lesion. The hack sign is a great predictor of injury, but it cannot confirm whether or not the rupture is complete.

Thomson’s test

With the patient face down and the knees flexed, the Thomson test consists of pulling the skin of the calves towards the knee.

This traction will tend to plantarflex the foot.

When there is a rupture of the Achilles tendon, if the extent of the injury is significant or total, this movement will not occur or will be minimal.

Like the Hack sign, this test does not confirm that the injury is there or that it is complete, but it provides information for its diagnosis.

Functional impotence

The lack of mobility can be caused by several reasons, but in this case, it is due to the rupture of the tendon itself, which makes it difficult for you to plantarflex the foot.

It is likely that there are compensations with other muscles and that you can perform that movement to a greater or lesser extent.

I explain everything in detail in chapter 2 of the book.

READ THE INDEX OF THE BOOK

2.4 Diagnosis of Achilles rupture. Imaging tests.

Ultrasound

Ultrasound is the first imaging test that is performed and with which it can be determined if the percentage of rupture is total or not.

If it is partial, ultrasound will allow estimating the percentage of tendon rupture.

Magnetic resonance

When some circumstances, such as fluid or accumulated oedema, do not allow correct visualisation of the damage, an MRI scan is used.

Here the superior quality of the image will confirm the type of injury and, if so, the extension of the Achilles tendon rupture.

But even so, it may not be possible to visualise it correctly due to the edema or because the patient has moved during the test, among other causes.

MRI SCAN for Achilles tendon rupture image

Exploratory surgery

Then, exploratory surgery is used to directly observe the extension of the rupture and its timely repair if it is confirmed.

Summary

As you have been able to read, the diagnosis of Achilles tendon rupture can be determined in various ways but taken all of them as a set of indicator signs, and except for imaging tests, no one can confirm such an injury in isolation.

3. Causes of Achilles Tendon injury.

3.1 How does the Achilles tendon tear?

The objective, in this case, is to understand how the Achilles tendon tears.

Knowing what the cause of your injury is can help you improve your rehabilitation or reduce the risk of rupture of the opposite Achilles tendon.

3.2 Why does the Achilles tendon rupture?

In some cases, it is complex to confirm why the Achilles tendon ruptures.

However, there are certain risk factors that will have a relevant influence.

Some of them can be modified or, at least, they can be worked on to reduce the importance of such risk.

Intrinsic risk factors.

Among the characteristic population data, there is a segment of people with a higher propensity to suffer Achilles tendinopathies.

In general, it tends to occur between the ages of 30 and 50 (varies according to the study) and with a greater proportion in men than in women.

On the other hand, the presence of the previous tendinopathy is not a predictor of rupture, since scientific evidence shows that in most cases the rupture occurs in tendons without previous symptoms.

It could even be said that previous pain would be a protective factor against a possible rupture.

Another frequent condition in the rupture occurs in periods of transition from a sedentary lifestyle to physical activities in a non-progressive way.

Specifically, people who return to an exercise or sport without prior rehabilitation work (as in the case of my Achilles injury, after my first year of parenthood) till that load, are more likely to suffer injuries; among others, the rupture of the Achilles tendon.

Extrinsic risk factors

Some extrinsic risk factors are caused by excessive and abrupt load support, such as falls or jumps from a certain height. The tendon is not able to withstand such a sudden load and ends up breaking.

Some accidents describe sharp injuries to the Achilles tendon due to sharp objects such as broken glass.

Iatrogenic causes are those caused by medications that, as a side effect, produce a degeneration of the tendons.

Among the medications that produce an alteration in the quality of the tendon tissues, we find corticosteroids and quinolones. The latter is frequently used antibiotics that are used both in the hospital and out-of-hospital setting.

Diabetes is another cause of Achilles tendon rupture, that is, the presence of high blood sugar levels since it seems to affect the quality of the tendons.

Prolonged corticosteroid treatments can be negative for the quality of the tendon, sometimes being difficult to modify due to personal health needs.

Modifiable causes of Achilles tendon rupture

In short, and regardless of whether the risk factors are internal or external, some risk factors can be modified.

Especially the one that refers to the transitions from a sedentary lifestyle to physical activity.

It is important that you make a gradual and controlled progression on your return to exercise, as this can be a determining factor when it comes to the appearance of symptoms in the different injuries, not only of the Achilles tendon.

If you don’t know how to do it, the ebook Improve your Achilles tendon rupture will be your ally for more than four months. Everything is detailed in chapter 6.

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With regard to extrinsic factors, specifically talking about diabetes, it is essential to maintain adequate blood sugar levels.

For this, diet, physical activity and appropriate treatment, if necessary, are crucial to maintaining the health of your tendons.

4. Walking with a torn Achilles tendon.

4.1 Can you still walk with a ruptured Achilles tendon?

Since my Achilles rupture in 2017, many patients and readers have asked me this question, especially when the rupture is partial and the plantarflexion function is not altered.

I’m going to explain to you why you can’t walk with a torn Achilles tendon.

4.2 Natural history and splinting

When you tear your Achilles tendon, either partially or completely, a whole cascade of events occurs that intervenes in reaction to that damage.

During this acute phase, initial bleeding occurs after which the appearance of platelets increases to stop it, to the point that even the immune system can be altered in response to the rupture.

An increase in repairing substances of the affected tissue is also triggered after the inflammatory phase, which is said to reach maturity around six weeks after the rupture.

This time coincides with the usual period that your leg is usually immobilised after the Achilles injury or surgery, although I am in favour of reducing it to several weeks earlier, as you need to start doing exercises as soon as possible.

In addition, the reason why they put you in an equine position splint after the rupture is to approximate the edges of the affected tendon so that it can heal better.

As with any scar, it takes time to mature so that the tendon can demand a certain load and tension, and it would be unwise to walk with the Achilles tendon torn if this time has not passed yet.

Much different is to start doing small partial supports a few weeks after the injury or surgery.

This Achilles tendon support must be guided and structured by a specialised professional so that you do not make it too abrupt.

But first, there are a thousand things to do, even with the splint or the Achilles walking boot in place. Did you know it?

IMPROVE YOUR ACHILLES TENDON

4.3 Walking with partially torn Achilles tendon

In case your question is whether it is possible to walk with a partial rupture of the Achilles tendon, the answer is no.

When you try to walk with a partially torn Achilles tendon, what you’re straining is the rest of the tendon that’s still attached and you have no way of knowing if it’s healthy or not.

In addition, since there is less tendon attached to the calcaneus, you will be demanding an even greater load from it than what it is used to receive.

That’s not a good idea.

4.4 A good rehabilitation

After an injury of this type, you will have the need to recover as soon as possible, for work, personal reasons, etc.

However, if you think you can walk with a ruptured Achilles tendon, you will not only be slowing down your recovery, but you will also be risking further injury, or worse, undesired side effects.

So that it does not happen, you have to be consistent on this path that is presented to you and, above all, be consistent with the decisions that you will have to make.

Rehabilitation ought to be the strongest point from the first minute to the last, and in that aspect, who better than someone specialised to recommend what you can do not to fail.

5. Treatment for Your Achilles Injuries.

5.1 Does torn Achilles Need surgery?

The different treatment options for Achilles tendon rupture may vary based on the cause or subsequent goals.

If you want to be a participant in choosing the treatment to follow, you must be aware of what one or another treatment implies.

As a physical therapist as well as a former patient with this injury, I am explaining to you the Achilles tendon treatment options available to date.

You will find two ways to approach this injury, especially at the beginning.

In conjunction with your referring doctor, you will have to opt for surgery or conservative treatment.

Conservative treatment. Will Achilles tendon heal itself?

If you wonder if the Achilles tendon will heal on its own,

In conservative treatment, a splint will be placed in the equine position to approximate the injured edges and the Achilles tendon will heal on its own.

The results are usually similar, with a slightly higher risk of re-rupture compared to surgery.

The splint will be left in place for approximately six weeks, although this time may vary.

Normally I usually recommend not to keep the splint so long, but in cases where there is no surgery, each patient should be assessed according to the existing conditions.

For example, if the injury represents a smaller percentage, a conservative treatment for the Achilles tendon could be done with a splint for less than six weeks, and then move on to the walker boot.

If the percentage is higher or complete, and the patient is sedentary and does not intend to perform moderate or intense exercise, the splint could be left on for up to six weeks.

In any case, many gentle rehabilitation activities can be carried out if the splint can be removed in a short time, and without affecting the quality of the tendon.

Or rather, it would affect, but positively, since we would be working on very important aspects that facilitate your improvement.

In short, conservative treatment of Achilles tendon rupture is indicated for sedentary patients, with little physical activity, for those with a small percentage of rupture, for those who do not want surgery, or for those with contraindications that prevent them from undergoing surgery.

Achilles tendon surgery.

On the other hand, Achilles tendon repair surgery is the Achilles tendon rupture treatment of choice for patients who intend to continue with moderate to intense physical activity or for situations of significant or complete rupture and with the intention of maintaining a certain level of physical activity.

Technically, surgery has in its favour a lower percentage of re-rupture compared to conservative treatment, but there are no major differences between one therapeutic option and the other.

With regard to the disadvantages arising from surgery, post-surgical pain and complications associated with the scar can appear, but they are also infrequent.

The open technique will have greater problems with the scar, while the percutaneous technique will leave a scar of a few centimetres and will minimise these risks.

Currently, the ultrasound technique is beginning to be used, almost without a scar and with fewer complications.

On the other hand, surgery is recommended in cases of rupture due to secondary causes of the use of medications such as corticosteroids or antibiotics called quinolones, which alter the quality of the tendon tissue.

For this reason, surgery is recommended, since the quality of the tendon can be assessed directly and sutured.

5.2 Rehabilitation after treatment of Achilles tendon tears

Choosing the type of treatment will help, especially in the first few weeks, to be able to manoeuvre more or less in the first phases of rehabilitation.

Surgery may allow you to progress the load a little more prematurely than in conservative treatment.

And the placement of the walker boot after the second week will be another determinant to stimulate your evolution.

Then, rehabilitation, with all its phases, will be one of the key factors that cannot fail. That’s the reason why almost half of my book Improve Your Achilles Tendon Rupture develops eight ultra-detailed fortnights for each leg, healthy and recovering.

Many doctors will tell you that it is not necessary, but there are countless things that can be worked on in the first few weeks and that will help you start the path to recovery with exceptional quality.

6. Achilles tendon rupture surgery.

You will discover here some technical details that are not usually explained before the operation and that are fundamental. The questions that are usually asked in this regard are the following:

6.1 What is Achilles tendon surgery like?

Surgery for Achilles tendon injuries will depend on the type of intervention performed, although, generally speaking, they will have some common characteristics.

Regarding the type of anaesthesia, epidural anaesthesia will be used mostly, but in some cases, it will be necessary to use general anaesthesia, if the intervention requires it.

Some sedatives may be used prior to anaesthesia to relax the patient.

Before the intervention, the patient is placed face down to perform the surgical technique.

And depending on the type of surgery, the incision will be larger or smaller.

Open Achilles Tendon Surgery

Open surgery allows the rupture to be seen with total comfort, as well as allowing the repair and union of the tendon to be carried out with less difficulty. On the other hand, the scar will be larger and there will be a greater risk of complications during the healing process.

All scar care is explained in chapter 4 (on nursing care).

Percutaneous Achilles tendon surgery

Percutaneous surgery presents a smaller incision and the technique is more complex due to the intention of preserving a reduced surgical wound.

It is probably the technique of choice nowadays since it presents lower risks of post-surgical complications and because the results are satisfactory even for athletes.

Achilles tendon ultrasound-guided surgery

The ultrasound-guided technique is a new and promising therapeutic option since the incision is minimal and carries practically no risk of post-surgical complications since the scar is millimetric.

The drawback could be due to the fact that more time is needed to evaluate its results since it is a relatively new technique.

Surgery using the WALANT technique

It is a very interesting technique whose acronym comes from Wide Awake Local Anaesthesia No Tourniquet.

It allows surgeons to actively assess the firmness of the repair through the active movement of the patient, without the need for sedation, or the use of the popliteal tourniquet and with greater post-surgical comfort, achieving very good results.

6.2 How long does the Achilles tendon operation take?

Achilles tendon surgery is an outpatient procedure, so you will be home the same day.

Anaesthesia can be local or epidural, and the postoperative period and hospital discharge depend on the control of your pain, your spontaneous urination and the possible variables that may exist according to your own medical history.

Once these variables have been controlled, you are discharged and can go home with analgesic medication to control the main postoperative symptom, pain.

6.3 When to support the foot after Achilles tendon surgery?

This is a point of great discrepancy.

On the one hand, the scientific evidence says that it is not clear that early support improves results.

However, consistent, very progressive support, from the second fortnight after surgery or injury, can be a great ally in improving the circulatory system, preparing for muscle activation, tolerance and pain-relieving, etc.

There are those who prevent the patient from supporting the foot until six weeks after Achilles tendon surgery.

But such late support does not make sense, since it will limit many of the activities that can be carried out in the first moments, even before the rehabilitation you receive.

You will learn how to do it in chapter 6. As you can see, a few things will be left to chance.

6.4 What happens if the Achilles tendon is not operated on?

If the Achilles tendon is not operated on the start times of rehabilitation and progression are probably slightly slower and more progressive than in those who have had surgery.

The risk of re-rupture of the tendon is slightly higher in the case of not having surgery to repair the Achilles tendon and for this reason, it may be recommended a late start of support.

Another slight difference occurs in recovery time.

The recovery time for Achilles tendon surgery can take 3 or 4 months and with a return to intense physical exercise averaging six months.

But, in the event that surgery is not performed, this period can be scheduled with a few weeks of delay, to ensure that the progression of loads is correct and thus reduce the risk of re-rupture.

In any case, being an expert on everything you can do to recover can be a key factor in returning to your usual life in the best possible way. Knowledge will allow you to make better decisions throughout your recovery.

7. How long does it take to recover from a ruptured Achilles tendon?

You are fallen on the ground, perplexed, and you know what has happened to you or you presume it.

You are in pain, or you are not, but what comes to mind is that tomorrow you will not be able to work, compete, or take care of your children.

You have no idea of how long the Achilles tendon heals, but you know that it will take months to recover and you do not know what sequels will stay.

As in item 6 you resolved some of the doubts about Achilles tendon surgery, now it is time to understand how long it takes to recover from a ruptured Achilles tendon.

7.1 Recovery from Achilles tendon injuries. Walk again.

Perhaps this is the first milestone of the entire recovery.

Normally, the partial support of a few kilos is given after the first fortnight and progresses until reaching a partial load in which a crutch can be removed.

Then progress is made to full support where the second crutch is removed.

The way to do it (THE BOOK, THE BOOK, THE BOOK), is essential to be able to advance correctly towards this goal. In the middle, there will be many details to take into account.

The full support time will range between a month and a half and three months, depending on several factors of the injury and your sensations during your recovery.

Some patients feel firm from the beginning and, with the specialist’s permission, they can increase weight from an early stage and at a good pace.

Others will have a lot of insecurity, muscle weakness or inhibition, pain, and may have a slower progression in increasing foot support.

Total static support will come first, and then support will gradually be given during walking, progressively eliminating crutches and boots.

7.2 Driving after an Achilles tendon rupture.

Being able to drive after the rupture of the Achilles tendon is one of the greatest concerns of my patients since in many cases the return to work and the redirection of the family economy will be up to it.

This aspect will also have a variable resolution time since it will depend on the strength acquired and the reaction capacity you have with your foot unless you do not care if you have a traffic accident.

When I explain the separate exercises on a fortnightly basis in the book, I seek, among other things, that you recover strength, mobility and, above all, motor control. This point is key to fine-tuning the quality and quantity of the force you apply.

Otherwise, even though you have strength, you may not command the foot in the same way. And some of the exercises detailed in the book are aimed at exactly that. Give quality and control to your movements.

7.3 Return to exercise

In this case, nothing prevents you from stopping exercising.

If we leave a few days of rest after the injury or surgery, nothing bad will happen.

But nothing stops you from exercising your upper body.

And the opposite leg? The great forgotten one.

For this reason, throughout the rehabilitation that I propose in the book, the exercises that you can do on the healthy leg from day one are also described.

7.4 Return to sports time

For those who until the time of the injury performed intense physical exercise and competition, this is a delicate matter.

Depending on the type of sport you do, the recovery time for Achilles tendon injury will be shorter or longer.

It will depend on the load that is applied in such sport, as well as changes in speed, turns and unexpected movements.

For the first activities, you will have the exercise bike and the treadmill, when you reach 100% charge. And the bike, with the walker boot on, will be quick to implement, around the first four to six weeks.

Then, one of the first sports you can do will be swimming, in which there is no support load except for the impulse against the wall.

For other sports, it will be necessary to wait between four and six months, such as running at high intensities and with degrees of incline.

For sports that require greater effort, support, changes of pace, turns and speed, such as soccer, tennis, paddle tennis, basketball, etc., an adequate recovery time of 6 to 8 months is estimated, having done a very good rehabilitation.

The perseverance and an adequate design of the rehabilitation throughout this entire process will be what will mark the recovery time of your Achilles tendon injury.

8. Achilles tendon rupture rehabilitation.

Rehabilitation of the operated Achilles tendon

Starting rehabilitation for Achilles tendon rupture is perhaps the most difficult step after surgery or conservative treatment.

It generates doubts, fears, and contradictions due to all the half information that you find everywhere.

And this step must be firm, with knowledge. Otherwise, it may affect the recovery time.

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8.1 How is the Achilles tendon postoperative period?

After hospital discharge, the first days are the most complicated due to the difficult mobility of the patient, in addition to the possible pain.

However, many things can be done in terms of rehabilitation during the Achilles tendon postoperative period.

Very simple exercises of the limb in recovery, of the opposite leg and the trunk and upper limb, can be enough to keep you busy for a good part of the day.

With this, you will have a circulatory and nervous system activation that will positively stimulate the tissues on which you work.

In addition, some measures of self-care of the wound and stimulation of the tissues can be started, as long as you have managed to get the walker boot put on instead of the splint.

8.2 When to start loading after Achilles tendon surgery?

The support can and should be started after the first fortnight, but not in any way. In my personal case, I started it after the first visit to the traumatologist.

The first point to take into account is the progression of the supported body weight.

The progression must be weekly as it is explained in the book Improve your Achilles Tendon Rupture, where you will find a safe and orderly way to do it correctly.

This process will last a couple of months, with variations according to each case.

Another condition is that the support must be very light and must not cause pain.

Besides, the support in the first phases does not have to produce important circulatory alterations, such as increased swelling, which can occur, but not in an extreme way.

8.3 How long does Achilles tendon rehabilitation last?

The duration of the rehabilitation of the Achilles tendon will depend on your evolution.

As I have developed in the book, you will find yourself with eight fortnights until you achieve the phase of free exercise and physical activity.

If you practice high-impact sports, it is likely that your rehabilitation and readaptation to the sport will last from four to six months, and may reach eight months in the cases of both amateur and professional competition.

8.4 Start as soon as possible.

There is much ignorance of everything that can be done from the first days, and absolute rest tends to be prescribed for the first weeks after the injury.

Nothing is further from reality.

The earlier you start, the better you will get to the final stages.

But you have to know how to do it.

8.5 Achilles tendon rupture rehabilitation protocol

If there is something essential in any rehabilitation after an Achilles tendon rupture, it is to know where you are and where you are going.

Without this, it’s just seeing what happens. And seeing what happens is not an option if you want to make a full recovery.

For this reason, structuring and planning properly what is going to be done is crucial.

In addition, giving rise to the variations of each personal case is a practice that must be taken into account. Each case is unique.

Hence, in the protocol developed in the book, I insist both on controlled progression and on advancing or regressing towards later or earlier phases, depending on how every patient is.

In short, the scientific method is applied.

Ask yourself where you are.

Evaluate.

Apply.

Return to Reassess.

8.6 What exercises can I do after an Achilles tendon operation?

You can find two million exercises to rehabilitate your Achilles tendon.

But few of them will take into account the following:

What phase are you in?

How much weight can you load?

How is your sensitivity?

And your strength?

You will then understand that proposing exercises without an action plan does not make much sense.

To find that fine adjustment, I had to make a great effort according to each fortnight, choosing the most relevant exercises of every moment, described in full in the book.

These exercises must be aimed at covering the following aspects:

● Mobility.

● Force.

● Engine control.

● Symptom control.

● Proprioception.

If every one of them is covered, the chances of suffering sequels after this injury will be minimal.

9. Sequels of Achilles tendon rupture.

9.1 Introduction.

It is possible that after the rupture of the Achilles tendon you are concerned about the appearance of sequels such as swelling, pain or loss of muscle mass.

Some of them tend to resolve themselves, but it is best to know what to expect in order to react on time and avoid further setbacks.

My greatest wish is that you use my personal and professional experience in your favour and that you also achieve success in your recovery.

Although this article is explained in chapter 7 (between pages 191 and 198) of my book Improve your Achilles tendon rupture, you will find a summary of the most common sequels.

9.2 Loss of muscle mass.

Loss of muscle mass is one of the most common sequels after Achilles tendon rupture.

From the beginning of the injury, the muscles lose tone and volume.

After surgery and the immobilisation process, this loss can become more evident, which in some cases makes recovery harder.

In my Achilles rupture, this was the biggest inconvenience after surgery.

However, early rehabilitation with very gentle and progressive exercises from the beginning was essential to start reversing this lack of muscle mass and inhibition of tone.

It is not the purpose here to describe what you can do to fix it. However, you will find in the book all the exercises that you can do for your complete recovery.

9.3 Pain after Achilles tendon repair surgery.

Is the Achilles tendon surgery painful?

Pain, in itself, is the most common symptom in most surgeries, not just trauma.

The Achilles tendon injury, although not notable for being painful, can be felt more after the repair surgery.

The presence of moderate to severe pain that is controlled with anti-inflammatories in the first 24-72 hours may be reasonable after surgery. In this case, there may be night pain due to the post-surgical inflammation process.

The pain should decrease as the days go by, although it is to be expected that mild to moderate pain will appear after the start of mobilisation and rehabilitation and that it should also be well tolerated.

Burning type pain that does not subside with anti-inflammatories. A compression process may occur due to the splint. In this case, it is appropriate to reassess the placement of a new one or move on to the use of the walker boot.

Immobilisation can also be a cause of joint pain. As you can see, early rehabilitation will play a fundamental role in your return to normality.

If the appearance of pain is outside these terms, it may be interesting to be evaluated by your reference specialist.

9.4 Lack of mobility in the foot.

Another of the most common drawbacks is the lack of movement in the foot, especially in the ankle joint.

It usually occurs mostly in the initial phases after the end of total immobilisation with the splint.

However, on some occasions, this condition continues over time due to the shortening of the tendon that prevents the full movement that the joint could allow.

It is more likely to happen if it is not properly worked during rehabilitation, or worse if you are not sent to do rehabilitation at any time.

Another more complex condition is lack of mobility due to lack of muscle activation. It usually occurs due to a nerve injury and should be assessed by a professional as soon as possible, to make the most appropriate decisions.

In many cases, it is necessary to perform an electromyogram to understand the involvement of the injured nerve and better define your probable evolution in this regard.

9.5 Leg swelling.

Leg swelling is also one of the most common sequels after Achilles tendon surgery.

During the first days, the alerts will be set on ischemic-type pain, nocturnal and that do not subside with conventional anti-inflammatories. In these cases, there may be pain caused by the compression of the splint on the inflamed leg.

Beyond this adverse event, oedema or inflammation are very frequent in the first days after surgery, since the tissues need a blood supply to heal and inflammation is a natural biological process that is triggered to repair the tissues.

With the passing of days and weeks, this condition should be reduced and will be focused on the moments of standing or performing the first exercises.

If over time it does not disappear, it should be evaluated by your reference health professional to take the appropriate measures.

Physical measures to help you solve it are explained in the book, of course.

9.6 Lack of sensitivity in the foot.

Another condition is a lack of sensitivity in the calf and foot region.

As in the previous ones, in the first days after Achilles tendon surgery, there may be a loss of sensitivity in some of the nearby areas, due to compression or the inflammatory process itself.

It should also gradually decrease, especially after the removal of the splint.

If this change does not occur, you will need to be explored in greater depth by your reference professional.

There are measures that can be taken to alleviate it, but an electromyogram may also be previously requested in case of suspected nerve conduction alteration.

Therapy options for this condition are described in the book.

10. Partial rupture of the Achilles tendon.

Should a partial Achilles tear be operated on?

Does it take the same time to recover?

Is rehabilitation done in another way?

Believing that a partial rupture of the Achilles tendon can evolve in less time can lead to unforeseen consequences, as I have already explained in point 9.

For this reason, you are going to solve questions related to the most frequent doubts about the partial rupture of the Achilles tendon.

10.1 Treatment of partial rupture of the Achilles tendon.

I remember like it was yesterday how many scientific studies I read the night I tore my Achilles tendon.

I needed to know what percentage of breakage I had to set myself as the maximum to decide to have surgery.

Most of the literature I reviewed agreed that surgery had some benefits over conservative treatment in my case.

But no one threw a breakage percentage from which to make that decision.

Everything depends on the context of each person, and in my context, I needed the best option to be able to return to non-competitive sport.

Finally, I set a conservative treatment limit of less than 35 per cent breakage.

For my greater peace of mind, the next day, I was diagnosed with an 80 per cent breakage. Although it sounds ironic or contradictory, this high percentage of breakage gave me firmness in the decision to make.

I would go straight to the operating room and solve it with a suture.

However, it is not always that simple, as there are multiple scenarios.

10.2 Recovery time for partial rupture of the Achilles tendon.

The time of your recovery, to reach the levels of what you consider your own normality, will be, in any case, practically similar to that of a complete rupture.

There are clinical cases treated with platelet-rich plasma that have improved recovery times, but even today there is no strong evidence to confirm it.

The repair times of each injured tissue are what they are and that time must be respected, but there are some interesting variations in the case of partial rupture.

The difference will lie in the final times of the rehabilitation, where you will probably find yourself with greater security and strength than a patient with a complete or almost complete tear.

Then, you will be able to advance in some exercises of moderate-intensity with greater ease and firmness, which will lead to gaining time in some aspects of your recovery.

10.3 Rehabilitation for partial rupture of the tendon.

As I have already anticipated before, the rehabilitation of a partial rupture of the Achilles tendon may not be very different from a complete rupture.

What you can do is, once the first three fortnights have passed, begin to activate the muscles with greater intensity.

Thus, perhaps as the weeks go by, you can tolerate greater weight loads and/or increase the resistance of the exercises, always keeping in mind the pain rule that I explain in the book.

On the other hand, in the final stages of your recovery, it is likely that greater changes will occur in terms of your physical abilities and that result will be translated into the reduction of the total time of rehabilitation, speaking in weekly terms.

What I am here to tell you is that although you may feel very well, the tissue that has been repaired must be respected and phases cannot be advanced without strictly controlling your symptoms, abilities, etc.