Achilles tendon tear

# Achilles Tendon Tear: Symptoms, Treatment, and Recovery

Sudden calf pain during sports. A whipping sensation. The inability to point your foot downwards. These signs often suggest an Achilles tendon tear. This injury primarily affects active individuals between 30 and 50 years old.

Here's the good news: with appropriate treatment and well-managed rehabilitation, the vast majority of patients regain their previous activity level.

As physiotherapists specializing in musculoskeletal rehabilitation, we regularly support patients after this injury. Physiotherapy plays a central role in your recovery, whether it's after surgery or with conservative treatment.

What is an Achilles Tendon Tear?

An Achilles tendon tear is a partial or complete rupture of the largest tendon in the human body. This tendon connects the calf muscles to the heel. It allows you to walk, run, and jump.

Achilles Tendon Anatomy

The Achilles tendon is 12 to 15 cm long. It can withstand forces 6 to 8 times your body weight during running or jumping.¹ An area located 2 to 6 cm above the heel receives less blood. Most ruptures occur in this vulnerable zone.²

The tendon is formed by the joining of the gastrocnemius and soleus muscles. These muscles make up the calf and allow for plantar flexion of the foot (pointing your foot downwards).

Types of Tears

Who is Most at Risk?

Ruptures affect 18 to 37 people per 100,000 annually.² Men are 5 to 10 times more affected than women.

What are the Symptoms of an Achilles Tendon Tear?

Symptoms include sudden calf pain, a whipping sensation, difficulty pointing the foot downwards, and rapid swelling above the heel.

Signs of a Complete Tear

• Sharp and sudden pain, described as feeling like a blow to the back of the leg
• An audible pop at the moment of injury (60-70% of cases)
• Inability to point the foot downwards against resistance
• A palpable gap in the tendon (the 'gap')
• Significant difficulty or inability to walk normally
• Swelling and bruising that appear in the following hours

Signs of a partial tear

• Calf pain but partial ability to point the foot
• Weakness when walking or climbing stairs
• Localized tenderness when the tendon is touched
• Moderate swelling

How is an Achilles tendon tear diagnosed?

Diagnosis is based on a clinical examination, including the Thompson test, feeling for a gap in the tendon, and if necessary, an ultrasound or MRI to confirm the extent of the injury.

Your physiotherapist or doctor will perform several tests:

TestMethodInterpretationReliability

Thompson TestCalf compression while lying on stomachNo flexion = probable tear96-100%

Gap PalpationChecking for a defect in the tendonPalpable gap = confirmed tear73-89%

Matles TestObservation of the foot with knee bent at 90°Foot drops = tear88%

Ultrasound confirms the diagnosis with 95-100% sensitivity.³ MRI is reserved for cases where a partial rupture is suspected or for surgical planning.

Surgery or conservative treatment: which option to choose?

The choice depends on your age, activity level, and preferences. Surgery offers a lower re-rupture rate but carries risks. Conservative treatment with a functional protocol yields comparable results for many patients.

Comparing the two approaches

Modern functional protocols, involving early weight-bearing and rapid mobilization, have significantly improved the outcomes of conservative treatment.⁴

How does physiotherapy help you recover from an Achilles tendon tear?

Physiotherapy is essential after an Achilles tendon tear. It includes progressive mobilization, gradual eccentric strengthening, proprioception, and preparing for a return to activities. This applies equally whether you've had surgery or are undergoing conservative treatment.

The phases of rehabilitation

Our approach is based on the latest functional protocols. We promote early and safe weight-bearing:

Techniques used in physiotherapy

• Ankle joint mobilization
• Soft tissue manual therapy
• Progressive eccentric strengthening program
• Proprioception and balance exercises
• Education on load management

Criteria for returning to sports

• Plantar flexion strength greater than 90% of the healthy side
• Ability to perform more than 25 single-leg calf raises
• Jump test symmetry index greater than 90%
• No pain during daily activities

How long does it take to recover from an Achilles tendon tear?

Recovery generally takes 4 to 6 months to resume normal daily activities and 6 to 12 months for a return to competitive sports. These timelines vary depending on the severity of the injury and the type of treatment.

Competitive Sports6-12 monthsFull return based on tests

Factors influencing your recovery

• Consistency with rehabilitation exercises
• Type of treatment chosen (slight advantage for surgery)
• Age and activity level before the injury
• Initial tendon quality

What exercises should you do to rehabilitate your Achilles tendon?

Rehabilitation progresses from passive mobility exercises to gentle stretches, then to isometric, eccentric, and finally plyometric strengthening. It is always important to respect the tissue healing phases.

Here are the exercises we prescribe to our patients based on their recovery phase:

Initial Phase (0-6 weeks)

• Ankle Pumps: flexion and extension movements of the foot without bearing weight
• Foot Alphabet: draw the letters of the alphabet with your toes to improve mobility
• Isometric Contractions: gently push your foot against a fixed resistance without movement

Intermediate Phase (6-12 weeks)

• Bilateral Calf Raises: rise onto the balls of your feet using both legs
• Gentle Stretches: gastrocnemius and soleus against a wall
• Stationary bike: light resistance, no pain
• Progressive walking: gradually increase distance

Advanced Phase (12+ weeks)

• Unilateral calf raises: rise onto your toes using only the affected leg
• Eccentric step-downs: slowly lower your heel below the step level
• Proprioceptive exercises: single-leg balance, unstable surfaces
• Introduction to jogging: begin if strength criteria are met

Your physiotherapist will adjust this progression based on your recovery and personal goals.

How to prevent a new Achilles tendon rupture?

To prevent a recurrence, maintain a regular eccentric strengthening program, warm up adequately before physical activity, gradually increase your workout intensity, and consult a professional if tendon pain persists.

With complete rehabilitation and these preventive measures, the recurrence rate is between 3 and 6%.⁵

When to consult a physiotherapist?

Consult a professional quickly if you experience the symptoms described in this article. Early diagnosis allows for appropriate treatment to begin without delay, optimizing your recovery.

You do not need to see a doctor before consulting a physiotherapist. If your condition requires surgery or medical advice, your physiotherapist will refer you to the right specialist.

Sources

1. Józsa L, Kannus P. Human Tendons: Anatomy, Physiology, and Pathology. Champaign, IL: Human Kinetics; 1997.

1. Park SH, Lee HS, Young KW, Seo SG. Treatment of Acute Achilles Tendon Rupture. Clin Orthop Surg. 2020;12(1):1-8. doi:10.4055/cios.2020.12.1.1

1. Ochen Y, Beks RB, van Heijl M, et al. Operative treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review and meta-analysis. BMJ. 2019;364:k5120. doi:10.1136/bmj.k5120

1. Willits K, Amendola A, Bryant D, et al. Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. J Bone Joint Surg Am. 2010;92(17):2767-75.

1. Barfod KW, Bencke J, Lauridsen HB, et al. Nonoperative dynamic treatment of acute Achilles tendon rupture: the influence of early weight-bearing on clinical outcome. J Bone Joint Surg Am. 2014;96(18):1497-503.