Achilles tendon tear
It is a partial or complete tear of the Achilles tendon fibers.
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# Achilles tendon rupture: symptoms, treatment, and recovery
Sudden pain in the calf during exercise. A whiplash-like sensation. Inability to point the foot. These signs often indicate a torn Achilles tendon. This injury mainly affects active people between the ages of 30 and 50.
Here's the good news: with appropriate treatment and effective rehabilitation, the vast majority of patients regain their previous level of activity.
As physical therapists specializing in musculoskeletal rehabilitation, we regularly treat patients after this type of injury. Physical therapy plays a central role in your recovery. This is true both after surgery and with conservative treatment.
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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.
Anatomy of the Achilles tendon
The Achilles tendon is 12 to 15 cm long. It supports forces of 6 to 8 times your body weight when running or jumping.1 An area located 2 to 6 cm above the heel receives less blood. The majority of ruptures occur in this vulnerable area.2
The tendon is formed by the junction of the gastrocnemius and soleus muscles. These muscles make up the calf and enable plantar flexion of the foot.
Types of breakups
| Type | Definition | Residual function |
|---|---|---|
| Partial rupture | Less than 50% of fibers affected | Partially functional tendon |
| Complete rupture | Complete separation of the ends | Function severely compromised |
Who is most at risk?
Fractures affect 18 to 37 people per 100,000 per year.2 Men are 5 to 10 times more likely to be affected than women.
| Risk factor | Impact |
|---|---|
| Age 30-50 | Peak incidence |
| Fluoroquinolones | 2-6 times increased risk |
| Corticosteroids | Tendon weakening |
| Pre-existing tendinopathy | Increased risk |
| High-impact sports | Basketball, tennis, badminton |
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What are the symptoms of a ruptured Achilles tendon?
Symptoms include sudden pain in the calf, a whiplash-like sensation, difficulty pointing the foot downward, and rapid swelling above the heel.
Signs of a complete breakup
- Sudden, sharp pain, described as a blow to the back of the leg
- Audible popping sound at the moment of injury (60-70% of cases)
- Inability to point the foot downward against resistance
- Palpable space 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 rupture
- Pain in the calf but partial ability to point the foot
- Weakness when walking or climbing stairs
- Localized tenderness on palpation of the tendon
- Moderate swelling
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How is an Achilles tendon tear diagnosed?
The diagnosis is based on clinical examination using the Thompson test, palpation of a gap in the tendon, and, if necessary, an ultrasound or MRI scan to confirm the extent of the injury.
Your physical therapist or doctor will perform several tests:
TestMethodInterpretationReliability
Thompson testCalf compression while lying on stomachNo flexion = probable rupture96-100%
Palpation of the gapSearch for a defect in the tendonPalpable space = confirmed rupture73-89%
Matles testObservation of the foot with the knee bent at 90°Foot falling = rupture88%
Ultrasound confirms the diagnosis with 95-100% sensitivity.3 MRI is reserved for cases where a partial tear is suspected or to plan surgery.
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Surgery or conservative treatment: which option should you 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 in many patients.
Comparison of the two approaches
| Criterion | Surgery | Conservative |
|---|---|---|
| Re-breakage rate | 2-4% | 4-5% (modern protocol) |
| Risk of infection | 2-4% | None |
| Healing disorders | 5-10% | None |
| Final recovered force | 85-95% on the healthy side | 80-90% on the healthy side |
| Back to office work | 6-8 weeks | 8-10 weeks |
| Profile | Recommended option | Justification |
| Athlete, under 40 years old | Surgery | Optimal strength, fewer re-breaks |
| Large gap (more than 5 cm) | Surgery | Difficult to affix without intervention |
| Over 50 years old, sedentary | Conservative | Avoids surgical risks |
| Comorbidities (diabetes, etc.) | Conservative | High risk of scarring |
Modern functional protocols, with early weight bearing and rapid mobilization, have significantly improved the results of conservative treatment.
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How does physical therapy help with recovery from an Achilles tendon rupture?
Physical therapy is essential after an Achilles tendon rupture. It includes progressive mobilization, gradual eccentric strengthening, proprioception, and preparation for returning to activities. This applies equally after surgery and with conservative treatment.
The phases of rehabilitation
Our approach is based on the latest functional protocols. We promote early and safe weight bearing:
| Phase | Duration | Objectives | Interventions |
|---|---|---|---|
| 1. Protection | 0-2 weeks | Initial recovery | Boot, gentle passive movements |
| 2. Mobilization | 2-6 weeks | Range of motion | Active ROM, partial weight bearing |
| 3. Initial reinforcement | 6-12 weeks | Core strength | Isometric, light eccentric |
| 4. Advanced reinforcement | 12-20 weeks | Functional strength | Eccentrics, proprioception |
| 5. Back to sports | 20+ weeks | Performance | Plyometrics, sport-specific |
Techniques used in physical therapy
- Ankle joint mobilization
- Manual soft tissue therapy
- Progressive eccentric strengthening program
- Proprioception and balance exercises
- Teaching about load management
Criteria for returning to sport
- Plantar flexion strength greater than 90% on the healthy side
- Ability to do more than 25 toe raises
- Symmetry index in jump test greater than 90%
- No pain during daily activities
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How long does it take for an Achilles tendon tear to heal?
Recovery generally takes 4 to 6 months to resume normal daily activities and 6 to 12 months to return to competitive sports. These timeframes vary depending on the severity of the injury and the type of treatment.
| Step | Approximate time frame | What you can do |
|---|---|---|
| Walking without boots | 6-8 weeks | Normal walking without limping |
| Return to work | 6-10 weeks | Seated position tolerated |
| Return to physical work | 12-16 weeks | Demanding physical tasks |
| Recreational sports | 4-6 months | Swimming, cycling, light jogging |
Competitive sports6-12 monthsFull recovery according to tests
Factors influencing your recovery
- Attendance at rehabilitation exercises
- Type of treatment chosen (slight advantage for surgery)
- Age and activity level before injury
- Initial tendon quality
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What exercises should you do to rehabilitate your Achilles tendon?
Rehabilitation progresses from passive mobility exercises to gentle stretching, then to isometric, eccentric, and finally plyometric strengthening. It is important to always respect the phases of tissue healing.
Here are the exercises we prescribe to our patients according to their stage of recovery:
Initial phase (0-6 weeks)
- Ankle pumps: flexion and extension movements of the foot without putting weight on it
- Alphabet with your feet: draw the letters of the alphabet with your toes to improve mobility.
- Isometric contractions: gently push your foot against a fixed resistance without moving.
Intermediate phase (6-12 weeks)
- Bilateral elevations: rise up onto your toes with both legs
- Gentle stretches: gastrocnemius and soleus against a wall
- Stationary bike: light resistance, pain-free
- Progressive walking: gradually increase the distance
Advanced stage (12+ weeks)
- One-legged raises: stand on the tiptoe with only the affected leg
- Eccentric on steps: slowly lower your heel below the level of the step.
- Proprioceptive exercises: balancing on one leg, unstable surfaces
- Introduction to jogging: start if the strength criteria are met
Your physical therapist will adjust this progression according to your progress and personal goals.
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How can you prevent another Achilles tendon rupture?
To prevent recurrence, maintain a regular eccentric strengthening program, warm up properly before physical activity, gradually increase the intensity of your workouts, and consult a doctor if tendon pain persists.
| Prevention strategy | Practical application | Frequency |
|---|---|---|
| Eccentric strengthening | Step elevations, slow descent | 2-3 times a week |
| Proper warm-up | 10-15 minutes before activity | Each session |
| Gradual progression | Maximum 10% per week | Continue |
| Symptom monitoring | Consult if pain persists | If necessary |
With comprehensive rehabilitation and these preventive measures, the recidivism rate is between 3 and 6%.5
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When should you see a physical therapist?
Consult your doctor immediately if you experience any of the symptoms described in this article. Early diagnosis allows you to begin the appropriate treatment without delay. This will optimize your recovery.
You do not need to see a doctor before consulting a physical therapist. If your condition requires surgery or medical advice, your physical therapist will refer you to the appropriate specialist.
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Sources
1. Józsa L, Kannus P. Human Tendons: Anatomy, Physiology, and Pathology. Champaign, IL: Human Kinetics; 1997.
2. 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
3. Ochen Y, Beks RB, van Heijl M, et al. Surgical treatment versus non-surgical treatment of Achilles tendon ruptures: systematic review and meta-analysis. BMJ. 2019;364:k5120. doi:10.1136/bmj.k5120
4. 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.
5. 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.
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