What is Achilles Tendon Rupture? Symptoms, Causes, & Treatment

An Achilles tendon rupture is a complete or partial tear of the thick band of tissue that connects your calf muscle to your heel bone. This injury happens suddenly and can feel like someone kicked you in the back of your leg, even when no one is around.

Your Achilles tendon is the largest and strongest tendon in your body, but it's also one of the most commonly injured. When it ruptures, you'll likely hear a distinct "pop" sound and experience immediate pain and difficulty walking. The good news is that with proper treatment, most people recover fully and return to their normal activities.

What are the symptoms of Achilles tendon rupture?

The most telling sign of an Achilles tendon rupture is a sudden, sharp pain in the back of your ankle or calf. You might feel like someone struck you with a baseball bat or kicked you hard in the leg.

Here are the key symptoms you might experience:

• A loud "pop" or snapping sound when the injury occurs
• Severe pain near your heel that may improve quickly
• Swelling and bruising around your heel and lower calf
• Difficulty pointing your foot downward or pushing off when walking
• Inability to stand on your toes on the injured leg
• A gap or depression in the tendon area you can feel with your finger

Some people describe feeling like their calf muscle "rolled up" toward their knee. You might also notice that your injured leg feels weaker than usual, making it hard to climb stairs or walk uphill.

In rare cases, you might experience numbness or tingling in your foot if the rupture affects nearby nerves. This isn't common, but it's worth mentioning to your doctor if it happens.

What causes Achilles tendon rupture?

Most Achilles tendon ruptures happen during sports activities that involve sudden acceleration, jumping, or quick direction changes. The tendon simply can't handle the sudden, intense force placed on it.

Common activities that can trigger this injury include:

• Basketball, tennis, or racquet sports with quick starts and stops
• Running or sprinting, especially when increasing intensity suddenly
• Jumping activities like volleyball or gymnastics
• Dancing with sudden movements or leaps
• Stepping into a hole or off a curb unexpectedly
• Falling from a height and landing awkwardly on your feet

Your risk increases if your Achilles tendon has been weakened over time. This weakening often happens gradually through small tears that develop from repetitive stress, poor blood supply to the area, or age-related changes in the tendon tissue.

Sometimes, the rupture occurs during everyday activities like climbing stairs or stepping up onto a sidewalk. This is more likely if you have underlying tendon problems or take certain medications that can weaken tendons.

When to see a doctor for Achilles tendon rupture?

You should seek immediate medical attention if you hear a pop in your calf or heel area followed by sharp pain. Don't wait to see if it gets better on its own, as early treatment leads to better outcomes.

Head to the emergency room or urgent care if you experience a sudden snap or pop sound combined with immediate severe pain in your heel area. You should also seek prompt care if you can't point your foot downward or stand on your toes on the affected leg.

Even if your pain isn't severe, difficulty walking normally or a feeling that your calf muscle has "bunched up" toward your knee warrants immediate medical evaluation. These signs strongly suggest a complete rupture that needs professional treatment.

If you notice gradual onset of heel pain, swelling, or stiffness over several days, schedule an appointment with your doctor within a few days. These symptoms might indicate a partial tear or tendonitis that could lead to a complete rupture if left untreated.

What are the risk factors for Achilles tendon rupture?

Several factors can increase your chances of experiencing an Achilles tendon rupture. Understanding these risk factors can help you take preventive measures and stay aware of your vulnerability.

Age plays a significant role, with most ruptures occurring in people between 30 and 50 years old. During this time, your tendons naturally lose some flexibility and strength, but you might still be very active in sports or physical activities.

Your activity level and sports participation also matter:

• Weekend warriors who exercise intensely but infrequently
• People who suddenly increase their activity level or training intensity
• Athletes in sports requiring jumping, pivoting, or sudden acceleration
• Individuals returning to sports after a long break

Certain medical conditions can weaken your Achilles tendon over time. These include diabetes, which can affect blood flow to the tendon, and inflammatory conditions like rheumatoid arthritis or lupus that can cause tendon inflammation.

Some medications, particularly fluoroquinolone antibiotics like ciprofloxacin, can increase your rupture risk. Corticosteroid injections near the Achilles tendon can also weaken the tissue, though this is less common.

Previous Achilles tendon problems, including tendonitis or small tears, create scar tissue that makes the tendon more vulnerable to rupture. Additionally, having flat feet or overpronation can put extra stress on your Achilles tendon during activities.

What are the possible complications of Achilles tendon rupture?

While most people recover well from Achilles tendon ruptures, some complications can occur, especially without proper treatment. Understanding these possibilities helps you appreciate why prompt medical care is so important.

The most common complication is re-rupture of the tendon, which happens in about 2-5% of cases. This risk is higher if you return to activities too quickly or don't follow your rehabilitation program properly.

Other potential complications include:

• Chronic weakness in your calf muscle and difficulty pushing off when walking
• Ongoing pain and stiffness in your heel and ankle area
• Decreased ankle flexibility and range of motion
• Difficulty with activities requiring calf strength like climbing stairs or running
• Blood clots in your leg if you're immobilized for extended periods

Surgical complications, though rare, can include infection, nerve damage, or problems with wound healing. Some people develop thick scar tissue that can cause ongoing discomfort or limit ankle movement.

In rare cases, people experience deep vein thrombosis (blood clots) during the immobilization period, especially if they're not moving around much. This is why your doctor might recommend specific exercises or blood-thinning medications during recovery.

Without treatment, your Achilles tendon might heal in a lengthened position, permanently weakening your ability to point your foot downward or push off when walking. This can significantly impact your daily activities and sports performance.

How can Achilles tendon rupture be prevented?

You can significantly reduce your risk of Achilles tendon rupture by taking care of your calf muscles and tendons through regular stretching and strengthening. Prevention is always better than dealing with this painful injury.

Start with gentle calf stretches as part of your daily routine. Hold each stretch for 30 seconds and repeat 2-3 times, especially before and after physical activities. Focus on both straight-leg and bent-knee calf stretches to target different parts of your calf muscle complex.

Strengthen your calf muscles with exercises like calf raises, both seated and standing. Gradually increase the difficulty by doing single-leg calf raises or adding resistance. Strong, flexible calf muscles provide better support for your Achilles tendon.

When increasing your activity level, do it gradually. Follow the 10% rule by increasing your exercise intensity, duration, or frequency by no more than 10% each week. This gives your tendons time to adapt to increased demands.

Choose appropriate footwear for your activities. Shoes with good heel support and cushioning can reduce stress on your Achilles tendon. Replace worn-out athletic shoes regularly, as they lose their shock-absorbing properties over time.

Pay attention to early warning signs like heel pain, morning stiffness, or tenderness along your Achilles tendon. Address these symptoms early with rest, ice, and gentle stretching before they progress to more serious problems.

How is Achilles tendon rupture diagnosed?

Your doctor can often diagnose an Achilles tendon rupture through a physical examination and your description of how the injury occurred. The combination of your symptoms and specific physical tests usually provides a clear picture.

During the examination, your doctor will look for visible signs like swelling, bruising, or a gap in your tendon. They'll gently feel along your Achilles tendon to check for areas of tenderness or depression where the rupture occurred.

The Thompson test is the most reliable diagnostic tool for complete ruptures. You'll lie face down while your doctor squeezes your calf muscle. If your Achilles tendon is intact, your foot should point downward automatically. If it doesn't move, this strongly suggests a complete rupture.

Your doctor might also ask you to try standing on your toes on the injured leg. If you can't do this or it causes significant pain, it's another strong indicator of an Achilles tendon rupture.

Sometimes, imaging tests help confirm the diagnosis or assess the extent of the injury. An ultrasound can show the location and size of the tear, while an MRI provides more detailed images of the tendon and surrounding tissues.

These imaging tests are particularly helpful if your doctor suspects a partial rupture or wants to plan surgical treatment. They can also rule out other conditions that might cause similar symptoms, like a calf muscle strain or heel bone fracture.

What is the treatment for Achilles tendon rupture?

Treatment for Achilles tendon rupture depends on several factors, including the completeness of the tear, your age, activity level, and overall health. Both surgical and non-surgical options can be effective when chosen appropriately.

For complete ruptures, surgical repair is often recommended, especially for younger, active individuals. The surgeon reconnects the torn tendon ends, which typically results in better strength and lower risk of re-rupture compared to non-surgical treatment.

Non-surgical treatment involves wearing a cast or special boot that keeps your foot pointed downward, allowing the tendon ends to heal together naturally. This approach works well for partial ruptures or for people who aren't good surgical candidates due to age or health conditions.

The typical non-surgical treatment process includes:

1. Initial immobilization in a cast or boot for 6-8 weeks
2. Gradual transition to a walking boot with heel lifts
3. Progressive weight-bearing as healing progresses
4. Physical therapy to restore strength and flexibility

Recovery time varies but typically takes 4-6 months regardless of treatment method. During this time, you'll work with a physical therapist to gradually restore your ankle's range of motion, calf strength, and overall function.

Your doctor will help you choose the best treatment approach based on your specific situation. Factors like your job demands, sports participation goals, and personal preferences all play a role in this decision.

How to manage Achilles tendon rupture at home?

While professional medical treatment is essential for Achilles tendon rupture, there are several things you can do at home to support your healing and manage discomfort during recovery.

In the first few days after injury, follow the RICE protocol: Rest, Ice, Compression, and Elevation. Apply ice for 15-20 minutes every 2-3 hours to reduce swelling and pain. Elevate your leg above heart level when sitting or lying down to minimize swelling.

Take over-the-counter pain medications like ibuprofen or acetaminophen as directed to manage pain and inflammation. However, check with your doctor first, especially if you're taking other medications or have health conditions that might interact with pain relievers.

Once your doctor approves, gentle range-of-motion exercises can help prevent stiffness and promote healing. Start with simple ankle pumps and circles, but only within your comfort range and as instructed by your healthcare team.

Protect your injured tendon by avoiding activities that stress it. Don't try to "walk through" the pain or test your strength too early, as this can worsen the injury or delay healing.

Pay attention to your nutrition during recovery. Protein helps with tissue repair, while vitamin C supports collagen formation. Stay hydrated and eat a balanced diet with plenty of fruits, vegetables, and lean proteins to support your body's healing process.

Watch for signs of complications like increased pain, redness, warmth, or fever, which might indicate infection or other problems. Contact your doctor immediately if you notice any concerning changes in your symptoms.

How should you prepare for your doctor appointment?

Preparing for your doctor appointment can help ensure you get the most comprehensive care and answers to your questions about your Achilles tendon rupture. A little preparation goes a long way in making your visit productive.

Write down exactly how your injury occurred, including the activity you were doing, any sounds you heard, and your immediate symptoms. This information helps your doctor understand the mechanism of injury and assess the likely extent of damage.

Make a list of all your current symptoms, including when they started and what makes them better or worse. Note any changes in your ability to walk, stand on your toes, or perform daily activities since the injury occurred.

Bring a complete list of your medications, including prescription drugs, over-the-counter medications, and supplements. Some medications can affect tendon healing or interact with treatments your doctor might recommend.

Prepare questions to ask your doctor, such as:

• Is my rupture complete or partial?
• What are my treatment options and their pros and cons?
• How long will recovery take?
• When can I return to work or sports?
• What activities should I avoid during healing?
• What are the signs of complications I should watch for?

Bring a family member or friend to your appointment if possible. They can help you remember important information and provide support during what might be a stressful time.

Wear loose-fitting pants or shorts that can be easily rolled up so your doctor can examine your leg thoroughly. Avoid tight clothing that might be difficult to remove for the physical examination.

What's the key takeaway about Achilles tendon rupture?

An Achilles tendon rupture is a serious but treatable injury that requires prompt medical attention for the best outcomes. While it can be frightening to experience the sudden pop and pain, understanding that effective treatments are available can provide reassurance during your recovery journey.

The most important thing to remember is that early diagnosis and appropriate treatment lead to better long-term results. Whether you choose surgical or non-surgical treatment, following your healthcare team's recommendations and being patient with the healing process are crucial for full recovery.

Most people who experience an Achilles tendon rupture return to their previous activity levels within 6-12 months. With proper rehabilitation and gradual return to activities, you can expect to regain full function and strength in your affected leg.

Prevention through regular stretching, gradual activity progression, and attention to early warning signs can help protect you from future injuries. Remember that your Achilles tendon is remarkably strong and, with proper care, can heal completely from even a complete rupture.