Achilles Tendon Rupture: Symptoms, Treatment and Recovery

01What

What is the Achilles tendon?

The Achilles tendon is the thickest and strongest tendon in the body. It connects the calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus), and transmits the force needed for walking, running, jumping and standing on tiptoe. The segment about 2–6 cm above the heel has a relatively poor blood supply and is the commonest place for ruptures.

02Causes

How and why it ruptures

• A sudden push-off, sprint, jump or abrupt change of direction, common in tennis, basketball, football and racket sports.
• A sudden unexpected dorsiflexion of the ankle, such as a misstep or fall.
• “Weekend warrior” pattern: sporadic intense activity in middle-aged people.
• Pre-existing tendon degeneration (Achilles tendinopathy).
• Fluoroquinolone antibiotics (such as ciprofloxacin and levofloxacin), corticosteroid injections or long-term oral steroid use.
• Obesity, diabetes, inflammatory conditions and age.
• Previous Achilles problems and certain medicines increase the risk.

03Symptoms

Symptoms

• A sudden pop or snap, sometimes a feeling of being kicked or hit in the back of the lower leg.
• Sharp pain at the back of the ankle or calf, which may settle quickly.
• Swelling and bruising.
• Weakness and difficulty pushing off, climbing stairs or rising onto tiptoe on the injured leg.
• A palpable gap in the tendon above the heel.
• The ability to walk (flat-footed) does not exclude a rupture: many ruptures are missed in the first visit.

04Diagnosis

How it is diagnosed

The Thompson (calf squeeze) test, in which the calf is squeezed while the patient lies face down: in a normal leg the foot flexes downward; in a rupture it does not. A palpable gap and reduced strength are other signs. Ultrasound or MRI can confirm the tear and measure the gap when the diagnosis is uncertain. Early diagnosis is important because delayed treatment leads to poorer results. See calf strain and peroneal tendonitis for other conditions around the ankle.

05First aid

What to do right away

• Stop activity and avoid weight-bearing as much as possible.
• Elevate the leg and use a cold pack for comfort.
• Seek medical assessment within 24–48 hours.
• The leg may be put in a splint or boot with the foot pointing slightly downward (equinus) to bring the tendon ends together.
• Pain relief with paracetamol; avoid anti-inflammatories if possible in the early stage unless advised.
• Do not massage or stretch the calf.

06Options

Surgery or non-surgical treatment?

Both options are reasonable, and the choice depends on your age, activity goals, general health, the type of rupture and local expertise. Randomised trials show that with modern accelerated rehabilitation protocols (early weight-bearing in a boot with heel wedges, and early motion), non-surgical treatment gives similar outcomes to surgery for the average patient, with fewer complications such as infection and wound problems, but a slightly higher risk of re-rupture in some studies. Surgery may be preferred for younger, high-demand athletes, late-presenting ruptures and those with ruptures close to the heel. Your specialist will discuss risks and benefits.

07Rehab

Rehabilitation timeline

• Weeks 0–2: protection in a boot with the foot pointing down; elevation, pain control.
• Weeks 2–8: progressive weight-bearing in a boot with heel wedges that are gradually reduced; gentle ankle movements as advised.
• Weeks 8–12: walking in normal shoes with a heel raise; start double-leg heel raises, balance and cycling.
• Weeks 12–24: progressive strengthening: single-leg heel raises, calf loading, jogging when strength allows (usually after 4–6 months).
• Months 6–12: return to sports and jumping, once strength, endurance and hop tests approach those of the other side.
• Follow your surgeon or physical therapist’s protocol exactly, as timelines vary.

08Complications

Possible complications

• Re-rupture, more likely if rehab is rushed.
• Deep vein thrombosis after immobilisation: watch for calf swelling and pain, and ask about preventive measures.
• Wound infection or poor healing after surgery.
• Sural nerve injury or numbness on the outside of the foot after surgery.
• Lasting calf weakness, a thickened tendon and stiffness.
• Smoking, diabetes and obesity increase complication risk.

09Prevention

Reducing the risk

• Warm up and build up intensity gradually, particularly with intermittent sports.
• Strengthen the calf and improve ankle mobility regularly.
• Treat Achilles pain early; do not ignore persistent heel or tendon pain.
• Avoid sudden increases in training load or hill work.
• Wear suitable footwear and replace worn shoes.
• Discuss risks of fluoroquinolone antibiotics and steroid injections with your doctor if you have previous tendon problems.

11Cases

Three common situations

A 40-year-old playing tennis feels a “kick” to the back of the leg and cannot rise on tiptoe: likely rupture; seek assessment within a day or two.

A runner with months of Achilles pain, then a sudden pop: underlying tendinopathy often precedes rupture; assess urgently.

A patient prescribed fluoroquinolone antibiotics develops heel pain: stop the activity and contact your doctor promptly.

12Summary

Key points to remember

Achilles tendon ruptures are serious but treatable. Get an early diagnosis, choose between surgery and non-surgical care with your specialist, follow a structured rehabilitation and expect recovery over 6–12 months. Our physical therapy team can guide you through each stage.

This guide is for general information and does not replace an assessment by your own doctor or physical therapist.