Achilles tendon rupture

An Achilles tendon rupture is a partial or complete tear of the Achilles tendon, the thick tendon at the back of the ankle that links the calf muscles to the heel bone. It usually happens suddenly during a push-off, jump, or quick change of direction, and it makes walking and rising onto the toes difficult.

• A sudden pop or snap at the back of the ankle, often described as feeling kicked in the calf
• Sharp pain at the back of the ankle or lower leg
• Swelling and bruising near the heel
• Difficulty walking, climbing stairs, or pushing off with the foot
• Being unable to rise up on tiptoe on the injured side

Most ruptures happen when the calf muscle contracts forcefully while the tendon is stretched — pushing off to sprint, jumping, landing, or making a sharp cut. Contact during sports, such as another player stepping on the heel, and falls or missteps can also tear the tendon.

Tendons that have been weakened beforehand are at higher risk. Risk factors include:

• Earlier Achilles tendinitis
• Steroid injections near the tendon, or steroid medications
• Certain antibiotics
• Diabetes, obesity, and some inflammatory or metabolic conditions

A clinician asks how the injury happened and examines the back of the ankle, including asking you to rise onto your toes or push against resistance. A key part of the exam is the calf squeeze (Thompson) test: when the calf is squeezed, the foot normally points downward, and if it does not move, a complete tear is likely.

The exam often makes the diagnosis on its own. Ultrasound or MRI may be used to confirm the tear, show where it is, or check for other injuries, and X-rays can show whether a small piece of the heel bone pulled away with the tendon.

Treatment aims to bring the torn tendon ends back together so they heal at the right length. Both non-surgical and surgical treatment can do this, and the choice is made with your surgeon based on the type of tear, your health, and your activity goals.

Non-surgical treatment holds the ankle in a cast, splint, or walking boot with the toes pointed down so the tendon ends rest close together. Over several weeks the foot is gradually brought back to a neutral position, usually within a structured rehabilitation program that allows early, protected movement. Partial tears are almost always treated this way.

Surgical treatment sews the torn ends together, or reattaches the tendon to the heel bone when it has pulled away from the bone. Surgery is often discussed for athletes and active people who rely on push-off strength. Repair is generally most straightforward when done soon after the injury, before the tendon ends pull apart and scar. Like any operation, it carries risks, such as wound problems, infection, nerve irritation, blood clots, and re-tearing.

With or without surgery, recovery follows a staged plan: a period of protection in a boot or cast, then gradual weight-bearing, then physical therapy to restore motion and calf strength. Getting back to everyday activities generally takes several months, and returning to sports usually takes longer. Some loss of calf strength is common. Your care team will tell you when it is safe to move to each stage.

• Stretch and strengthen the calf muscles regularly
• Warm up before sports, and build up intensity gradually
• Have Achilles pain evaluated rather than playing through it
• Ask your clinician about tendon risks before a steroid injection near the tendon, and when starting a medication known to affect tendons