Achilles tendon rupture

What it is

How reviews define it

One narrative review, a summary written without a set, checkable search method, describes an acute rupture as a sudden tearing of the Achilles tendon^1,2. Another groups sudden tears as a range: microtears, partial tears, interstitial tears inside the tendon, and complete ruptures^1,2. The tendon joins the calf muscles to the calcaneus (heel bone), as the Achilles tendon page sets out³.

Two views of the bones of the right lower leg and foot, with the lower thigh bone and the kneecap, and the calf muscles drawn in blue. From behind, two long blue muscle bellies start just above the back of the knee and run down the calf, with a flatter blue muscle beneath them. Below the blue, an orange band narrows as it runs down the back of the ankle and ends on the back of the heel bone. From the outer side, the blue calf muscles lie behind the shin bones, and the orange band runs down behind the ankle to the back of the heel bone. — The Achilles tendon and the calf muscles of the right leg, from behind and from the outer sideRendered by Your Basic Trainer from the Open 3D Model by AnatomyTOOL, which builds on Z-Anatomy and BodyParts3D (Database Center for Life Science). (source, CC BY-SA 4.0). Rendered from the 3D model in two labelled views with only the bones, the calf muscles (blue) and the calcaneal tendon (orange) shown, and the thigh bone cut off above the knee

How it happens

A 2026 review says rupture most often affects active people in sports with sudden speeding up, slowing down or jumping⁴. It adds that rupture also occurs in inactive and ageing people⁴. A 2022 narrative review links running, jumping and agility work with a higher risk⁹. It names work with eccentric loading (muscle work while the muscle lengthens) and explosive plyometric efforts (stretch, then quick shortening, as in jumping)⁹.

A video study of ruptures in professional male football (soccer) players found they happened as players sped up¹⁰:

Speeding forward from standing: 42%¹⁰
Cross-over cutting: 25%¹⁰
Jumping straight up: 18%¹⁰

In those videos, the ankle was at the end of its dorsiflexion (foot pulled up toward the shin), at about 40 degrees¹⁰. Biopsies from 891 people with spontaneously ruptured tendons, mostly of the Achilles and biceps tendons, showed no healthy structure¹¹. Of the changes found, 97% were degenerative (worn-down tissue), against degenerative changes in 34% of matched control tendons¹¹.

How guidelines rate the evidence

A 2010 American Academy of Orthopaedic Surgeons guideline drew on systematic reviews (set, checkable searches of all the research)¹². It graded none of its 16 recommendations as strong¹². Most were graded inconclusive¹². A 2026 guideline from a committee of 40 orthopaedic surgeons listed when to operate, timing, open or minimally invasive technique, and post-operative plans as disputed¹³.

Who it affects

How common it is

The Achilles tendon page sets out the rates⁴. In brief, a meta-analysis (a study pooling earlier results) of 28 population studies found 15.7 per 100,000 person-years (people times years followed)⁴. Rates peaked at ages 30 to 49 in males and 40 to 49 in females, and males had about three times the rate of females⁴. The yearly rise was about the same in males (4.5%) and females (4.6%)⁴. Men aged 30 to 49 more often tore it in basketball or soccer, while women over 50 more often tore it outside sport⁴.

A review of 532 studies found their participants averaged 81% male and 19% female, with the female share rising slowly over time¹⁴. Only 10.7% of those studies reported results by sex, which limited what could be said about females¹⁴.

Sport and everyday activity

Group studied	What was found
28 population studies, in a 2026 review⁴	About 68% of ruptures linked to sport, especially ball and racquet sports⁴
Competitive athletes, in the same review⁴	The literature suggests only 4% to 18% of ruptures⁴
US emergency departments, 2012 to 2016¹⁵	81.9% during sport or recreation; basketball made up 42.6% of the sport-related ones¹⁵

The 2026 review found no standard definition of a sport-related rupture⁴.

Factors linked with it

A 2023 systematic review of 19 studies rated the evidence on risk factors as low to very low certainty¹⁶. The factors included steroids, quinolone antibiotics, Achilles tendinopathy, diabetes, earlier injury and regular athletic activity¹⁶. It could not extract data on movement or psychological factors¹⁶.

A meta-analysis of 15 observational studies, which watch without assigning groups, linked fluoroquinolone antibiotics with higher odds of rupture¹⁷. The odds ratio, how many times higher the odds were, was 2.52¹⁷. In public records of NBA players from 1958 to 2024, an earlier calf strain went with higher odds of rupture (odds ratio 2.49)¹⁸.

What studies found

How recovery runs over time

A 2022 narrative review concludes that healing probably lasts up to a year, perhaps more⁹. In the data it reviewed, the Achilles tendon Total Rupture Score reached only 82 of 100 at one year⁹. This is a score that people report themselves⁹. It did not noticeably improve after that⁹.

The same review reports the tendon can lengthen by 10 to 20 mm⁹. Different regimes after injury have not shown a significant cut in this lengthening⁹. It also reports side-to-side differences in calf muscle cross-sectional area (the size of a slice across the muscle) of 9% to 25% at 12 months⁹. Three to 13 years after, the differences were 11% to 15%, suggesting the loss may be permanent in some cases⁹. Single studies on the Achilles tendon page found calf deficits at seven years and a longer tendon 14 years after repair^19,20.

A trial of management without surgery followed 37 people 4.5 years after the injury²¹. Their injured side reached 82.4% of the other side’s heel-raise height²¹. Heel-raise work reached 60%, and the mean rupture score was 80.5²¹. A 2022 narrative review states that evidence on how best to restore function after a rupture is largely missing from the literature⁹.

Trials of surgery against no surgery

Trials compared repair by surgery, open or minimally invasive, with management without surgery^5,22:

Trial	Who	What was found
ACHILLES, Norway; funded by a regional health authority and a university hospital⁵	554 adults; no surgery, open or minimally invasive repair⁵	Rupture score change at 12 months did not differ (−17.0, −16.0, −14.7)⁵. Re-rupture 6.2% without surgery, 0.6% in each surgery group; nerve injuries 0.6%, 2.8% and 5.2%⁵
Canada²²	144 people, mean age 40.4; both groups bore weight and moved the ankle early²²	Re-rupture in 2 after surgery and 3 without; no clinically important strength or motion difference; 13 against 6 complications²²
Finland: one trial, two reports^23,24	60 people; surgery or no surgery^23,24. Both arms had the same programme afterwards: a cast for 1 week, then a brace for 6, with full weight-bearing after week 1²³	First report: at 18 months, 10% to 18% more calf strength after surgery, with similar performance scores²³. Second report, on muscle size: injured soleus 24.8% smaller without surgery and 17.7% after it; tendons 19 mm longer without surgery²⁴
Long-term follow-up²⁵	64 of 80 people, at a mean of 15.7 years²⁵	Scores on the SMFA, a function measure people report themselves, did not differ significantly²⁵. Re-rupture rates did not differ significantly²⁵
CARTA, Denmark; funding included 100,000 euros from DJO Global²⁶	300 adults; one arm chose surgery by ultrasound (a sound-wave scan) findings²⁶	No gain in heel-rise work at 12 months; re-rupture 3% in that arm against 11% without surgery²⁶

What pooled studies found

Four pooled analyses compared surgery with no surgery^6,7,8,27:

A 2010 Cochrane review: in 6 trials, open surgery went with fewer re-ruptures (risk ratio, how many times as often: 0.41)⁶. It went with more other complications, including infection⁶. The review, done to Cochrane’s published standards, found results on function inconclusive and many trials poor in method⁶.
A 2019 meta-analysis of 29 studies: re-rupture was 2.3% after surgery and 3.9% without, and complications 4.9% against 1.6%, mainly infection⁷. In studies with early motion, re-rupture did not differ significantly⁷.
A 2025 meta-analysis of 14 randomised trials (1,628 people): both kinds of surgery had fewer re-ruptures, and only open surgery had more complications²⁷. Function did not differ significantly²⁷.
A 2025 meta-analysis of 33 studies (35,896 people): surgery went with fewer re-ruptures and more return to sport, but more infections and nerve injuries⁸. The rupture score did not differ⁸.

The authors of the 33-study analysis rated re-rupture, return to sport and nerve injury as high certainty, and the rupture score as low⁸. They also noted that return to sport rested on few studies and people⁸. Over time, the 28-study incidence review found surgical repair rates peaked in 2003 and fell after, pointing to more care without surgery⁴. Comparing the two kinds of surgery, a 2018 meta-analysis of 8 trials found fewer complications and wound infections with minimally invasive repair²⁸. It found no difference in re-rupture or return to activity, on mostly low-quality evidence²⁸.

Casts, braces, movement and injections

Trials in people managed without surgery compared several approaches^29,30,31,32:

Cast or brace: in UKSTAR, 540 people at 39 UK hospitals wore a plaster cast or a brace for 8 weeks²⁹. Its main measure, the rupture score at 9 months, did not differ (74.4 against 72.8)²⁹. Re-rupture was 6% with the cast against 5% with the brace²⁹.
Early ankle movement: in one trial of 130 people, some moved the ankle five times daily in weeks 3 to 8³⁰. Others had 8 weeks of immobilisation (keeping a limb still)³⁰. The movements showed no benefit³⁰.
Earlier weight-bearing: a meta-analysis of 9 trials (1,046 adults) found no significant difference from weight-bearing within 4 weeks or later³¹.
Blood injection: in PATH-2, 230 adults had a platelet-rich plasma injection, part of their own blood prepared for injection, or a placebo (a dummy version)³². It did not improve muscle-tendon function or any other outcome³².

The UK’s National Institute for Health Research paid for UKSTAR, and a UK research programme paid for PATH-2^29,32. Neither funder had a role in design or analysis^29,32. A 2025 network meta-analysis, comparing many options at once across 29 trials, found no one mix of approach and weight-bearing timing best on all outcomes³³. Of newer options, such as nutraceuticals, biomaterials, cell therapies and anti-inflammatory drugs, the 2026 guideline states that no single approach has yet been shown to be the best way to speed or improve recovery¹³.

Return to sport

A 2016 meta-analysis of 108 studies (6,506 people) found 80% returned to play³⁴. Its authors concluded the rate depends on how return is measured³⁴. A 2025 review of 748 people after surgery found 77.4% returned to sport, at a mean of 8.1 months³⁵.

In a review of 15 studies of professional NFL, NBA, MLB and soccer athletes, 76% returned to professional play, at a mean of 11 months³⁶. Their performance fell compared with uninjured players³⁶. In 62 NBA, NFL and MLB players after surgery, 30.6% did not return³⁷. Those who did played less and worse at one year, but not at two, than matched players³⁷.

Connections

The rupture is a tear of the Achilles tendon, made of fibres from the gastrocnemius and soleus^1,2,38. The general case of this tissue is on the tendon page, which covers degeneration before rupture¹¹.

One review describes the calf raise test as a way to assess the calf muscles and the Achilles tendon³⁹. In 34 people about six years after a rupture, the injured leg showed large losses of ankle power in walking, jogging and one-legged hopping⁴⁰. In jogging and one-legged hopping only, its knee took more load than the other leg’s⁴⁰. A hopping exercise has its own page, pogo hops.