An Achilles tendon rupture is a tear of the thick cord at the back of your ankle that connects the calf muscle to the heel bone. It often happens suddenly during a sport or burst of activity, and many people report a pop. If you suspect one, get checked quickly.
What the Achilles tendon does
The Achilles is the largest tendon in the body. It lets you rise onto your toes, push off when you walk, and jump or sprint. When it tears, partly or fully, the calf muscle can no longer pull on the heel the way it should.
Because it works with every step, a torn Achilles affects walking, stairs, and getting out of a chair, not just sports.
What causes a rupture
Most ruptures happen during a sudden load on the tendon. The tendon may have been weakened beforehand by wear, often without any warning symptoms.
Age plays a part, because tendons gradually lose some flexibility and blood supply. That is why an everyday move that felt harmless at twenty can cause trouble later.
Common situations include:
- Sudden bursts of effort, like sprinting, jumping, or changing direction in basketball, tennis, soccer, or pickup games
- Stepping off a curb or into a hole and landing awkwardly
- A fall from a height
- Returning to sport after a long break without building up gradually
Who is more at risk
Rupture is most often seen in adults who play sports casually, sometimes called weekend athletes, mainly in the middle decades of life, and men are affected more often than women.
Other things that can raise the risk are:
- Long-standing Achilles tendinitis or heel pain
- Certain antibiotics from the fluoroquinolone family, which carry a warning about tendon problems. Never stop a prescribed medicine without talking to your doctor
- Corticosteroid injections near the tendon, or long-term steroid use
- Tight calf muscles or sudden increases in training
- Some medical conditions that affect connective tissue
Symptoms to look for
Signs of a rupture are often hard to miss, though some people mistake them for a calf strain.
If you are unsure, compare the two legs. The injured side may feel weaker when you try to rise onto your toes, and the calf may look different. When in doubt, have it examined rather than waiting to see if it settles.
Symptoms can include:
- A sudden pop or snap, sometimes described as feeling like being kicked in the back of the leg
- Sharp pain at the back of the ankle or calf
- Swelling and bruising around the heel
- A gap or dent that can be felt above the heel
- Trouble pushing off the foot, climbing stairs, or standing on tiptoe on that side
- Some people can still point the foot downward, so being able to move the ankle does not rule out a tear
How it is diagnosed
The doctor will examine the leg and check how the calf and tendon respond. A common exam involves squeezing the calf while you lie face down to see if the foot moves. X-rays can be taken in the office to rule out a broken bone, and further imaging may be arranged to see the tendon.
Treatment depends on the injury and your goals, and your orthopedic doctor will walk you through options. Early diagnosis matters, since delays can make treatment harder.
Lowering your risk of injury
You cannot prevent every rupture, but sensible habits help. Warm up before sports, stretch the calf muscles, and build up training and weekend activity gradually rather than all at once. Wear shoes with good heel support, and do not ignore ongoing heel or calf pain.
If you have Achilles pain that keeps returning, have it looked at before it turns into something worse. Tendons that are sore for a long time may be more fragile.
When to see an orthopedic doctor
Seek care the same day or next day if you feel a pop at the back of your ankle or cannot push off your foot. Until you are seen, avoid putting full weight on the leg, rest, and elevate it. Go to the ER or call 911 if there is severe pain, a deformed ankle, numbness, a cold or pale foot, or signs of a blood clot like a swollen, warm, painful calf with shortness of breath. Able Orthopedic & Sports Medicine in Forest Hills can evaluate the injury and take X-rays in the office.
Common questions
Can you walk with a ruptured Achilles?
Some people can walk with a limp, which is why a rupture is sometimes missed. You will usually have trouble pushing off or rising onto your toes.
Is an Achilles rupture the same as tendinitis?
No. Tendinitis is irritation and pain in the tendon. A rupture is a tear, and it usually comes on suddenly.
Do I need surgery for an Achilles rupture?
It depends on the injury and the person. Your doctor will explain the choices after an exam.
This article is for general education and is not a substitute for a visit with a doctor. If you think you have a medical emergency, call 911.