Achilles Tendon Tear
What Is an Achilles Tendon Tear?
The Achilles tendon is the thick, strong band of tissue connecting the calf muscles to the heel bone, allowing you to push off the ground when walking, running, or jumping. It’s the largest and strongest tendon in the body, but it’s also prone to sudden, complete rupture — often described by patients as feeling like being kicked or struck in the back of the ankle, even though nothing actually hit them.
What Causes an Achilles Tendon Tear?
- A sudden, forceful push-off motion, such as sprinting, jumping, or quickly changing direction — common in recreational sports like basketball, tennis, and pickleball
- Age-related degeneration of the tendon, which becomes less flexible and more prone to injury over time, particularly in “weekend warrior” athletes in their 30s to 50s who are less consistently active than in their younger years
- Fluoroquinolone antibiotics, which have been associated with a higher risk of tendon rupture
- Chronic Achilles tendonitis, which can weaken the tendon and make it more susceptible to a complete tear
What Are the Symptoms of an Achilles Tendon Tear?
- A sudden, sharp pain in the back of the ankle or calf, often described as feeling like being struck from behind
- An audible pop or snap at the moment of injury
- Immediate difficulty walking or bearing weight, though some patients are surprised they can still walk somewhat, just without normal push-off strength
- Swelling and bruising around the back of the ankle
- A palpable gap or defect in the tendon, felt a few inches above the heel
- Inability to rise up onto the toes on the affected leg
Can You Still Walk on a Torn Achilles Tendon?
Somewhat, which often surprises patients and can lead to a delay in seeking care. Because other muscles and tendons around the ankle can partially compensate, many patients are able to walk with a flat-footed limp, even with a completely torn Achilles tendon. However, they typically cannot rise up onto their toes on the affected leg or push off normally when walking — a key finding your provider will specifically test for during an exam, since it strongly suggests the tendon is torn even when walking is still possible.
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Treatment Options for an Achilles Tendon Tear
Both nonsurgical and surgical treatment can lead to good outcomes, and the right choice depends on factors like age, activity level, and the specific tear pattern.
Nonsurgical treatment involves a period of immobilization in a boot with the foot pointed downward, gradually adjusting the boot over time to bring the foot back to a neutral position as the tendon heals and shortens back to its normal length, followed by physical therapy to rebuild strength.
Surgical treatment involves reattaching the torn ends of the tendon with strong sutures, either through a traditional open incision or a smaller, minimally invasive approach. Surgery is often recommended for younger, more active patients or competitive athletes, since some studies suggest a modestly lower risk of re-rupture and a slightly stronger eventual push-off strength compared to nonsurgical treatment, though this must be weighed against the risks that come with any surgical procedure.
Regardless of which approach is chosen, recovery is a gradual process, typically requiring several months of progressive rehabilitation before returning to running or higher-impact sports, as the tendon needs substantial time to regain its normal strength and length.
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Dr. Palsis specializes in the treatment of knee, shoulder, and sports injuries.