Torn Achilles: Symptoms, Treatment & Recovery

A torn Achilles tendon is an injury in which the tendon that connects the calf muscles to the heel is suddenly overstretched and partly or completely tears.

When the tendon tears, a person may feel severe pain in the back of the ankle. They may also hear a popping sound and have trouble pushing the foot down.

This injury usually occurs during physical activity. In partial tears, surgery is often not needed, while complete tears usually require surgery.

Main symptoms

The main symptoms of a torn Achilles tendon are:

• Sudden, severe pain in the back of the ankle

• A “popping” sensation at the time of injury

• Swelling and bruising near the heel

• Difficulty or inability to push the foot downward

• Weakness or instability when walking

• Inability to stand on tiptoes

The area where the tendon is torn may also be tender to the touch. In some cases, it may be possible to feel a gap in the tendon, which suggests a rupture.

Confirming a diagnosis

A torn Achilles tendon is usually diagnosed by an orthopedic surgeon during a thorough physical exam. The doctor will examine the ankle and see how well the person can move their foot.

They may also do a Thompson test, which involves gently squeezing the calf while the person lies face down. If the foot does not move, it can be a sign that the Achilles tendon is torn.

In many cases, a physical exam is enough to make the diagnosis, but imaging tests such as ultrasound or MRI may be used to confirm the tear and see how severe it is.

Diagnosis and treatment should start as soon as possible, ideally within the first 48 hours, to help support better recovery.

Possible causes

A torn Achilles tendon can happen due to:

• Fast movements, such as sudden starts, abrupt stops, and quick changes in direction, as seen in soccer, basketball, and tennis

• Sudden upward bending of the ankle, such as when tripping on a step, going down stairs, or stepping into a hole

• Repeated tendinitis, which can weaken the tendon over time and increase the risk of rupture

A torn Achilles tendon may also be more likely in people with conditions such as obesity, diabetes, or arthritis.

According to the FDA, fluoroquinolone antibiotics, including ciprofloxacin and levofloxacin, carry a boxed warning for tendinitis and tendon rupture. Frequent use of corticosteroid (cortisone) injections may also increase the risk.

Another factor that can weaken the tendon and increase the risk of rupture is doing high-intensity sports only occasionally. This pattern is sometimes called “weekend warrior syndrome.”

Treatment options

Treatment may vary based on how severe the tear is, as well as a person’s age, activity level, and overall health. It may include:

1. Immobilization

Immobilization is the most common treatment for less active people, older adults, or people with health conditions that increase surgical risks, such as diabetes or circulation problems.

The foot and ankle are immobilized with an orthopedic boot, cast, or brace. The foot is kept pointed downward to bring the ends of the tendon closer together and allow it to heal on its own.

During this type of treatment, it is important to avoid activities like walking more than 500 meters (about 0.3 miles) or climbing stairs. You should not put weight on the foot, although it can rest on the floor while sitting.

Immobilization avoids the risks of surgery but has a higher chance of the tendon tearing again. According to the American Academy of Orthopaedic Surgeons, nonsurgical treatment can help the tendon heal without surgery. However, when combined with early physical therapy, results can be similar to surgery.

2. Surgery

Surgery is usually recommended for younger and more active people or when there is a complete tear. It may be done as:

• Open Achilles tendon repair: In this type of surgery, the doctor makes a larger incision in the back of the ankle to directly stitch the torn tendon.

• Minimally invasive Achilles tendon repair: This procedure uses small incisions and special instruments to reconnect the tendon, causing less pain, leaving smaller scars, and allowing a faster return to activities.

After surgery, resting the leg is recommended during the first few days. Keeping the leg elevated above heart level can help reduce swelling and pain.

The orthopedic surgeon usually places an orthopedic boot, cast, or splint to protect the tendon and limit movement for about 6 to 8 weeks.

However, depending on the type of surgery and individual recovery, weight-bearing may gradually begin, along with early physical therapy. Crutches may be needed at first.

3. Physical therapy

Regardless of the initial treatment, physical therapy is essential for restoring strength, flexibility, and mobility in the Achilles tendon. It should begin only after being cleared by the orthopedic surgeon.

Physical therapy may include treatments such as ultrasound, laser therapy, and other techniques used to help relieve pain and improve local circulation.

Joint mobilization techniques may also be used for the knee, ankle, and foot. Cold compresses, massage therapy, and gentle stretching of the leg muscles may also be included.

As pain and inflammation improve, progressive strengthening of the calf muscles is started, usually with resistance bands of different strengths.

In the final stage, proprioception exercises are included to help restore balance, coordination, and confidence when walking.

Torn Achilles recovery time

Recovery from a torn Achilles tendon varies depending on the severity of the injury and each person’s progress. It usually takes four to six months and happens in stages, such as:

• First weeks, when the goal is to control pain and swelling while protecting the tendon so it can heal properly.

• Rehabilitation phase, when physical therapy plays an essential role in restoring movement, strength, and confidence when walking.

• Return to daily activities, which happens gradually. Higher-impact activities, such as sports, require more time and caution.

In general, surgery reduces the risk of another tear. However, it may involve complications that delay recovery, such as infection, wound-healing problems, and, with minimally invasive techniques, injury to the sural nerve.

Does a torn Achilles tendon return to normal?

When the Achilles tendon tears, it does not return exactly to its original state. However, it can recover much of its function with proper treatment and physical therapy.

The tendon heals and becomes stronger over time, but its internal structure may remain slightly different. Full strength or flexibility can take months to return, especially for high-impact activities.