Achilles Tendon Rupture

First steps if you think you tore your Achilles

1. Stop the activity and do not try to "walk it off".
2. Keep weight off the leg. Use crutches if you have them.
3. Apply ice wrapped in a cloth for 15 to 20 minutes, and raise the leg.
4. Keep the foot pointed down (toes away from you), which brings the torn ends closer. Do not stretch the calf.
5. Get assessed within 24 to 48 hours. Early diagnosis matters, because delays of more than a few weeks make treatment more complicated.

What the Achilles tendon does

The Achilles is the largest and strongest tendon in the body. It joins the two main calf muscles (gastrocnemius and soleus) to the heel bone. It lets you push off when walking, run, jump and stand on tiptoe. It can carry forces several times body weight during running.

The tendon has a relatively poor blood supply about 2 to 6 cm above the heel, which is where most ruptures happen.

Symptoms

• a sudden pop or snap at the back of the ankle
• a feeling of being kicked or hit in the back of the leg, often leading people to turn around to see who did it
• sharp pain at first, which may settle quickly
• weakness pushing off, a flat-footed limp, and difficulty climbing stairs
• inability to stand on tiptoe on the injured side
• swelling and bruising around the ankle
• a palpable gap in the tendon

Pain can be surprisingly mild, and people can often still walk because other muscles can point the foot down. This is why up to a fifth of ruptures are initially missed or mistaken for an ankle sprain.

Causes and risk factors

• Sudden forceful loading: pushing off to sprint or jump, landing from a height, or the foot being suddenly forced upward, such as stepping into a hole.
• Age 30 to 50, often "weekend warriors" doing intermittent intense sport.
• Male sex: men are affected several times more often than women.
• Pre-existing tendon degeneration: many ruptured tendons show prior wear, even without previous symptoms. See Achilles tendinitis.
• Fluoroquinolone antibiotics (such as ciprofloxacin and levofloxacin), especially in people over 60 or also taking steroids.
• Steroid injections near the tendon.
• Obesity, gout, rheumatoid arthritis and kidney disease.

Diagnosis

Physical examination

• Thompson test: you lie face down with your feet over the edge of the table. The doctor squeezes your calf. Normally the foot points down. In a complete rupture it does not move. This simple test is highly accurate.
• Matles test: lying face down with knees bent to 90 degrees, the injured foot hangs more flat (less pointed) than the other.
• Palpable gap in the tendon.
• Weak or absent tiptoe stance.

The AAOS guideline suggests that two or more of these findings are enough to diagnose a rupture.

Imaging

• Ultrasound: confirms the rupture, measures the gap between the ends, and is quick and inexpensive.
• MRI: useful for partial tears, chronic ruptures or uncertain cases.
• X-ray: rules out a heel bone avulsion fracture.

Treatment: surgery vs boot

Both approaches give good results when non-surgical treatment uses modern functional rehabilitation with early weight-bearing.

Rehabilitation timeline (typical)

• Weeks 0 to 2: boot or cast with the foot pointed down, crutches, protected weight-bearing as advised.
• Weeks 2 to 8: gradual weight-bearing in a boot, wedges reduced step by step, gentle range-of-motion exercises.
• Weeks 8 to 12: out of the boot, into a shoe with a heel lift, walking normally, strengthening begins.
• Months 3 to 6: progressive calf strengthening, balance work, jogging from around 4 to 6 months if strength allows.
• Months 6 to 12: return to sport, guided by calf strength and single-leg heel raises.

Physical therapy is central to recovery. Overstretching the tendon early can leave it permanently lengthened and weak.

Blood clot prevention

Being in a boot or cast with reduced mobility raises the risk of deep vein thrombosis. Your doctor will assess your risk and may prescribe blood thinner injections or tablets. Report calf swelling, pain or breathlessness immediately.

Complications

• re-rupture, most often in the first 3 to 6 months
• tendon lengthening with lasting push-off weakness
• wound infection or healing problems after surgery
• sural nerve injury, causing numbness on the outside of the foot
• blood clots
• chronic (neglected) rupture, which may need tendon grafting or transfer surgery

Outlook

Most people return to walking normally within 3 months and to most activities by 6 to 12 months. Many athletes return to their previous level, though some notice slightly reduced calf strength long-term.

Prevention

• build calf strength with regular heel raises
• warm up before sport and increase training intensity gradually
• avoid sudden jumps in intensity after periods of inactivity
• use fluoroquinolone antibiotics only when needed, and stop and seek advice if you develop heel pain while taking one

Frequently asked questions

What does a torn Achilles feel like?

Most people feel a sudden pop and a sensation of being kicked in the back of the ankle. There may be sharp pain at first, then swelling, a limp and weakness pushing off. Many people can still walk, which is why the injury is sometimes mistaken for a sprain.

Can you walk with a ruptured Achilles tendon?

Often yes, with a flat-footed limp, because other muscles can still point the foot downward. However, you cannot push off strongly or stand on tiptoe on the injured leg. Walking on it before assessment can widen the gap, so keep weight off it.

How is an Achilles rupture diagnosed?

Doctors use the Thompson test: squeezing the calf normally makes the foot point down, but not when the tendon is torn. A palpable gap and weak tiptoe stance support the diagnosis. Ultrasound or MRI can confirm it and measure the gap.

Is surgery necessary for an Achilles tendon rupture?

Not always. Non-surgical treatment in a functional boot with early weight-bearing gives similar results for many people, with fewer complications. Surgery may be preferred for athletes, delayed diagnosis, a large gap or a re-rupture. Discuss the options with an orthopedic surgeon.

How long does it take to recover from an Achilles rupture?

Most people walk normally in a shoe by about 3 months. Return to running is usually around 4 to 6 months, and to full sport by 6 to 12 months. Calf strength can keep improving for a year or more with continued exercise.