Achilles tendon rupture

What it is

The Achilles is the thickest tendon in the body and the only connection your calf muscles have to your heel. A rupture is a complete tear across it, almost always two to six centimetres above the heel bone, in a stretch of tendon with a poor blood supply. In most cases the tendon had been quietly degenerating for months or years, with or without pain, before the day it let go. Once it is torn the calf can no longer pull on the heel, so push-off, heel raises and jumping are gone, but many people can still walk flat-footed, which is exactly why ruptures get sent home as a calf strain.

How volleyball causes it

The typical moment is a sudden push-off: driving off one foot to block a ball you were not set for, sprinting off the net to chase a tip, or planting to change direction after a shanked pass. The tendon fails where a fast, forceful contraction meets a foot being shoved into a deep bend, so an awkward landing or a step into a soft hole in the sand can do it too. It skews heavily toward players in their thirties, forties and fifties who play once or twice a week at high intensity in a body that trains at a lower one, and it clusters at the start of the first game and the end of the last. A large share of these players had an Achilles that had been stiff and achy in the mornings for months and was played through.

BlockingAttackingDefense

What it feels like

• A loud pop or bang that people nearby often hear, plus certainty that somebody kicked or hit you in the back of the leg. Players turn round to find nobody there.
• Immediate inability to push off, sprint, or rise onto the toes on that leg, even though walking flat-footed is often still possible.
• A gap or dent you can feel in the cord a few centimetres above the heel, at least until swelling fills it in over the first day.
• When you kneel on a chair with your feet hanging over the edge, the injured foot hangs looser than the other, and squeezing the calf does not make it point down the way the intact side does. A clinician calls this the calf-squeeze or Thompson test.
• Surprisingly little pain after the first minute, which is one of the main reasons it gets underestimated on the night.

Stop and get it seen if

• Any suspected rupture is itself urgent. Get seen the same day, stay off it, and do not test it by trying to jump or push off. Delayed diagnosis narrows the treatment options and worsens the result.
• Numbness, pins and needles, a foot that is cold, pale or blue, or a calf that becomes hard, tight and steadily more painful. That is a circulation or compartment problem and belongs in an emergency department, not a clinic queue.
• Any break in the skin over the tendon or a wound at the injury site. An open tendon injury is a surgical emergency because of infection risk.
• Once you are in a boot or cast: new calf swelling, warmth and pain, or any breathlessness or chest pain. Immobilisation raises clot risk, and a clot that travels to the lungs is life-threatening.
• After surgery: fever, spreading redness, increasing wound pain, or any discharge from the wound. Infection over a repaired Achilles is serious and time-critical.

What recovery usually looks like

Stages, not a schedule. Everyone moves through these at their own pace, and the ranges are wide because real recoveries are.

1. 1. Diagnosis and the first decision

   first 24 hours to 2 weeks

   Confirm what has happened, protect the tendon in a shortened position, and decide with a surgeon between surgical repair and managed non-surgical healing.

   • The foot is held pointed down in a boot with heel wedges, or in a cast, usually with crutches at first.
   • A complete tear has been confirmed clinically or on ultrasound, and how well the torn ends meet has been assessed.
   • There is a named plan for how long in the boot and when the wedges come out.
   • Pain and swelling settle quickly, which feels reassuring and tells you nothing about healing.

2. 2. Protected healing

   6 to 12 weeks

   Let the tendon heal at the right length, neither too long nor too short, while load is reintroduced in controlled steps.

   • Heel wedges come out in stages and the foot moves back toward flat inside the boot.
   • Weight through the leg progresses from partial to full while still booted.
   • The calf is visibly wasted next to the other side, which is expected at this stage.

Ready to play again when

• Cleared by the surgeon or physiotherapist who managed the injury. This is not a decision to make on feel.
• Single-leg heel raise within about 10 to 20 percent of the other side for both height and repetitions.
• Repeated single-leg hopping with symmetrical height and controlled, quiet landings.
• Full approach jump and block jump off either leg with no drop in take-off height and no tendon pain the next day.
• Full training sessions completed before any match play, not the other way round.

Keeping it from coming back

This is ordinary training, so unlike the rest of this page it does tell you what to do.

• Treat a grumbling Achilles as a warning rather than a nuisance and get it looked at. Most ruptures happen in tendons that were already degenerating, and months of morning stiffness is the clearest advance signal you will ever get.
• Heavy slow calf raises twice a week, straight-knee standing and bent-knee seated, through full range off a step. For a midweek-league player this is the closest thing to rupture insurance that exists.
• If you play once or twice a week at full intensity, train on the days you do not play. The classic rupture is a fit-enough person with an unfit tendon, because tendons adapt far more slowly than the heart and lungs.
• Keep a plyometric base year-round with skipping, pogo hops and low box landings, built up gradually, so an all-out push-off in game three is not the hardest thing your calf has done in six months.
• Warm up properly before the first competitive point, including short sprints and a few progressive approach jumps, and keep moving between games rather than sitting cold on the bench.
• Ramp your beach exposure rather than switching over in a week. Barefoot play takes the ankle through more range with no heel lift and no elastic return from the ground, which is a genuine step up in tendon load.