Fun fact: Did you know that Brad Pitt ruptured his Achilles during the filming of Troy, playing the role of Achilles? Oh, the irony.
The Achilles is one of the most common tendons to rupture, even though it is the strongest tendon in the body. It connects the calf muscles to the back of the heel bone. It is meant to facilitate walking and running, but based on its anatomy and spring-like function, it is especially well-suited for jumping and hopping. The mechanism of injury is often during a forced dorsiflexion movement, like stepping back quickly and overstretching the calf (think of Kevin Durant’s injury against the Raptors in 2019).
People in their 30’s and 40’s typically injure their Achilles while playing sports like basketball or tennis, while other causes of this injury can be jumping down from a height (e.g. jumping ashore from a boat), or pushing a heavy object with the foot planted. Men are 5x more likely to rupture their tendon than women (higher sport participation, reduced flexibility and different hormones can be partially blamed for this).
Surgery or no surgery?
Achilles ruptures were managed conservatively for centuries with splints. Surgery only started to become a common treatment option in the first half of the 20th century. It was around that time when the (second) battle of Achilles started: what’s more effective? Today, the heated debate continues. The conclusion is the following: both treatments can be effective. Successful outcomes may depend more on what we do afterwards, particularly the quality and timing of the rehabilitation.
People often opt for surgery because 1) they know elite athletes had it, 2) it is difficult to imagine that the Achilles can mend together on its own without any stitches. The fact is that it certainly can, and one year after the rupture, the calf strength and other functional outcomes are very similar whether you had surgery or not.
What happens during the rehabilitation process?
Scheduling an initial physiotherapy session (in-person or virtual) within the first few weeks of the injury can be extremely helpful. An experienced physiotherapist can address any questions left unanswered after the specialist appointments. They will also provide you with appropriate general exercises to help keep you moving, and prescribe range of motion, and gentle strengthening exercises for the foot, once safe to do so. The bulk of the rehabilitation starts around the 8-12 week mark, which is when you will discontinue using the walking boot. Your physiotherapist will guide you through learning to walk properly again, and provide you with a progressive calf strengthening program. Preventing re-ruptures, rebuilding muscle strength in the entire lower leg, returning to running and other sports is a result of a lengthy rehab process lasting 6-12 months.
Why choose a CAMPT-certified physiotherapist?
Working with a CAMPT-certified physiotherapist means that they will progress you through the stages of recovery in an appropriate and timely manner, according to the latest evidence. They can provide manual therapy when needed, and quickly address issues related to the prolonged and necessary use of the walking boot and the resulting compensations. Following the best evidence while tailoring the treatment to the individual can help everyone who suffers an Achilles rupture reach their desired goals, get better, recover faster and stay healthy!
The bottom line when it comes to Achilles tendon rupture
Achilles ruptures are easy to diagnose, but often difficult to treat. As a patient with an Achilles rupture, it can be overwhelming to hear a variety of opinions from different sources (surgeon, physiotherapist, Dr. Google). The rehabilitation process is one of the longest among common sport injuries, and it requires a high level of commitment from both the patient and the physiotherapist. Starting physiotherapy from the very early stages, staying consistent with exercises, and being patient are the cornerstones to recovery!
About Orsi Timar
Orsi is an empathetic and dedicated FCAMPT physiotherapist in downtown Toronto. She has experience in treating a variety of orthopaedic conditions ranging from sport to repetitive strain impairments, with a special interest in running injuries. Orsi is well versed in kinesiology, with extensive knowledge of sport-specific movement patterns, biomechanics, and technique. Outside of work Orsi is an avid runner, but you can find her in the gym, or in the yoga room. She also enjoys the outdoors, hiking, traveling, and spending time with her dog, Stella. Find out more about Orsi on her Website, Instagram & Facebook.