Achilles Tendon Rupture

An Achilles tendon rupture is a tear of the tendon that connects your calf muscle to your heel bone. It is almost always a full tear, and often happens suddenly, accompanied by sudden pain or a snapping sound. This injury can make it difficult or impossible to walk properly. Early treatment—surgical or nonsurgical—is important for a strong recovery.

What Causes an Achilles Tendon Rupture?

The Achilles tendon is the largest tendon in the body and is essential for walking, running, and jumping. Common causes for a rupture include:

• Sudden increases in physical activity
• Jumping or pivoting during sports
• Falls or tripping

What Are the Symptoms?

Symptoms of an Achilles tendon rupture can include:

• A popping or snapping sound at the time of injury
• Sharp pain in the back of the ankle
• Swelling near the heel
• Inability to stand on tiptoe
• Weakness or stiffness when walking

How Is an Achilles Tendon Rupture Diagnosed?

Diagnosis typically involves:

• A physical exam, including the Thompson test (squeezing the calf to check foot movement)
• Imaging tests, such as ultrasound or MRI, are helpful but are not routinely needed

How Are Achilles Tendon Ruptures Treated?

Treatment depends on the severity of the rupture and the patient's activity level.

Nonsurgical Treatments

• Immobilization in a boot or cast
• Gradual weight-bearing with physical therapy
• Stretching and strengthening exercises

Surgical Treatments

Surgery may be recommended for active individuals to restore full function and reduce the risk of re-rupture. These procedures include:

• Open repair: The surgeon makes an incision and stitches the torn tendon back together.
• Minimally invasive repair: Smaller incisions are used to access and suture the tendon. 
• Augmentation: In severe cases, a tendon graft or reinforcement may be added for extra strength.

What Are the Risks?

Risks of Achilles tendon surgery can include:

• Infection
• Nerve damage
• Blood clots
• Re-rupture
• Stiffness or weakness in the tendon
• Need for additional surgery

What Is Recovery Like?

Recovery can take several months and includes:

• Wearing a boot or cast for several weeks
• Gradual return to weight-bearing activity
• Physical therapy to restore strength and flexibility
• Return to sports or high-impact activity usually in 4–6 months

What Is the Outlook for Achilles Tendon Rupture Surgery?

Most people regain full function with proper treatment. The ultimate goal is to restore full strength and power, and that requires a careful plan. Surgery generally offers a lower risk of re-rupture and faster return to activity compared to nonsurgical treatment.