Achilles Tendon Rupture Causes, Symptoms & Treatment
The calf has two muscles: the gastrocnemius and the soleus. They meet to form the Achilles tendon, the large fibrous cord that runs down the back of your lower leg. It connects the calf muscles to the heel bone. The Achilles tendon is used for push-off strength, balance, and power while standing, walking, running, and jumping. This tendon can tear, creating pain at the time of the rupture, and then making it difficult to walk or run.
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The calf is made up of two muscles—the gastrocnemius and the soleus—which merge to form the Achilles tendon. This strong, fibrous cord runs down the back of the lower leg and attaches to the heel bone (calcaneus). It plays a critical role in balance, propulsion, and explosive movements such as sprinting and jumping.
An Achilles tendon rupture occurs when this tendon is subjected to excessive force, causing it to tear. Once ruptured, normal movement becomes difficult, and without proper treatment, long-term weakness and loss of function may occur.
What causes Achilles Tendon Rupture?
An Achilles tendon rupture is most commonly caused by a forceful contraction of the calf muscles while the tendon is simultaneously being stretched.
1. How the Injury Occurs
- Sudden acceleration or push-off movements
- Jumping or landing awkwardly
- Rapid changes in direction
- Unexpected strain on a tight or fatigued tendon
These actions place extreme stress on the tendon, leading to tearing.
2. Common Causes
- Overuse or repetitive stress on the tendon
- Poor conditioning or inadequate warm-up
- Tight calf muscles
- Previous Achilles tendon injury
- Degenerative changes in the tendon over time
Sports Commonly Associated with Achilles Tendon Rupture
Achilles tendon ruptures are most common in sports that involve explosive lower-leg movements:
- Basketball – jumping and rapid direction changes
- Tennis and racquet sports – sudden starts, stops, and lunges
- Soccer – sprinting, cutting, and pushing off the foot
- Running – repetitive stress and sudden increases in intensity
Athletes in these sports are at higher risk for Achilles tendon injuries, especially without proper conditioning.
Symptoms
An Achilles tendon rupture often occurs suddenly and may be partial or complete. Many patients report feeling as though they were kicked or struck in the back of the leg.
Common Achilles tear symptoms and signs of Achilles rupture include:
- Sudden, sharp Achilles tendon pain, often at the back of the ankle
- Swelling around the heel or calf due to inflammation
- Weakness, especially when pushing off the foot
- Difficulty walking, running, or standing on tiptoes
In many cases, patients may be unable to bear weight on the affected leg.
When to see a doctor
You should see a doctor immediately if you experience:
- A popping or snapping sensation in the heel or calf
- Sudden Achilles tendon pain followed by weakness
- Difficulty walking or pushing off the foot
During the examination, your doctor will look for signs of Achilles rupture, including swelling, tenderness, a gap in the tendon, or abnormal calf positioning.
Thompson Test
To help confirm the diagnosis, your doctor may perform the Thompson test, in which you lie face down with your knees bent. When the calf muscle is squeezed, the foot should normally move downward. If it does not, this strongly suggests an Achilles tendon rupture.
Imaging
- MRI may be ordered to assess the severity and extent of the injury
- Ultrasound may also be used in some cases
Non-operative treatment
Treatment for an Achilles tendon rupture depends on your age, activity level, and the severity of the injury. Non-surgical treatment may be appropriate for less active individuals or partial tears, though it carries a higher risk of re-rupture.
Conservative Treatment Options Include:
- Using crutches to reduce weight bearing on the tendon
- NSAIDs (such as ibuprofen or naproxen) to manage pain and inflammation
- Ice application to reduce swelling
- Compression to control inflammation
- Immobilization with a brace or walking boot to keep the ankle stable
- Physical therapy to restore strength, flexibility, and function after the tendon has healed
These approaches aim to reduce Achilles tendon pain and allow the tendon to heal naturally.
(Refer to the PDF Exercise Program below)
Achilles Tendon Tear
Surgical Treatment
Your doctor may recommend surgery, particularly if you are young, active, or have a complete rupture. Surgical repair involves stitching the torn ends of the tendon back together.
Pros and Cons of Surgery
- Advantages: Lower risk of re-rupture and better strength recovery
- Risks: Infection, nerve injury, and wound complications
Despite these risks, surgery is often preferred for athletes who wish to return to high-demand activities.
Recovery
Recovery from an Achilles tendon rupture requires time and commitment to rehabilitation, whether treated surgically or non-surgically.
Recovery Timeline
- Initial immobilization and rest for several weeks
- Gradual progression to weight-bearing exercises
- Physical therapy focused on strength, balance, and flexibility
Athletes can typically return to sports within 4–6 months, although full recovery—including strength and endurance—may take 6-12months.
Dr. Jay Kimmel is a board-certified orthopedic surgeon specializing in sports medicine, arthroscopic surgery, and shoulder and knee disorders. He completed his orthopedic training at New York-Presbyterian/Columbia University Medical Center and a Sports Medicine Fellowship at Temple University.
Dr. Kimmel previously served as the Director of the Connecticut Sports Medicine Institute at Saint Francis Hospital and has held faculty appointments as Clinical Assistant Professor in the Departments of Orthopedics and Family Medicine at the University of Connecticut. He has extensive experience caring for athletes as a team physician for high school and collegiate programs and continues to teach in the athletic training departments at Westfield State University and Springfield College.
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/MonthFrequently Asked Questions
Can you walk with a ruptured Achilles tendon?
Some people can walk with a limp, but push-off strength is significantly reduced.
Is surgery always required for an Achilles tendon rupture?
No. Some partial ruptures can be treated non-operatively, though surgery lowers the risk of re-rupture.
How long does recovery take after an Achilles tendon injury?
Most patients recover functional walking within months, but full athletic recovery may take up to two years.
What increases the risk of Achilles tendon rupture?
Risk factors include poor conditioning, tight calf muscles, sudden increases in activity, prior Achilles tendon injury, and participation in high-impact sports.