DIMITRIOS BALTZIS · Patient Information
What is an Achilles tendon rupture?
An Achilles tendon rupture is a partial or complete tear of the tendon connecting the calf muscles to the heel bone. It commonly occurs in the midportion of the tendon, several centimetres above its insertion. Sudden push-off, sprinting or a change of direction can trigger the injury.
Common symptoms
People often describe sudden pain or the sensation of being kicked in the calf, sometimes with an audible pop. Push-off power is reduced, standing on tiptoe becomes difficult and a gap may be felt along the tendon. Being able to walk does not rule out a complete rupture.
Diagnosis
Clinical examination and comparison with the other leg are central. Findings may include an abnormal Thompson/Simmonds calf-squeeze test, altered resting ankle position and reduced plantarflexion power. Ultrasound can help confirm the location and degree of tearing and assess approximation of the tendon ends in plantarflexion. MRI is reserved for selected or complex presentations.
Immediate care
A suspected rupture requires prompt orthopaedic or trauma assessment. Until then, protecting the ankle in a plantarflexed position is generally appropriate; forceful stretching and unprotected walking should be avoided. The treating clinician determines weight-bearing instructions.
Non-operative treatment
Functional non-operative treatment using a dedicated boot or brace, initially with the ankle plantarflexed, is a well-established option for suitable acute ruptures. Outcomes depend on appropriate tendon-end approximation, adherence to a structured rehabilitation protocol and follow-up. The ankle position and permitted loading are adjusted gradually.
Surgical treatment
Repair may be considered for selected patients, including certain tear configurations, inadequate tendon-end approximation, high functional demands or repeat rupture. Open, minimally invasive and percutaneous techniques are available. Choice depends on tendon quality, time since injury, individual risks and patient goals.
Surgery or non-operative treatment?
Both approaches are accepted. Surgery may reduce the risk of re-rupture but carries risks such as wound complications, infection and nerve injury. Modern functional non-operative pathways can provide good outcomes. The most suitable approach is selected through individual examination and shared decision-making.
Functional rehabilitation
A supervised rehabilitation plan is essential regardless of treatment type. A boot or brace protects the tendon early on, followed by controlled movement and progressive loading. Excessive early dorsiflexion or aggressive stretching may compromise healing. Strength, balance and sport-specific exercises are introduced as healing permits.
Recovery and return to sport
Rehabilitation takes several months. Running and jumping sports usually require a longer progressive recovery period, and strength may continue to improve for twelve months or more. Decisions should be based on function, strength, movement and clinical progress rather than the calendar alone.
Risks and warning signs
Complications may include re-rupture, persistent weakness, tendon elongation and adhesions; surgery also carries wound and nerve risks. Injury and temporary immobilisation increase the risk of venous thromboembolism, and prevention is assessed individually. Sudden breathlessness, chest pain or marked new calf swelling require urgent medical assessment.
References
- AAOS OrthoInfo – Achilles Tendon Rupture (Tear)
- Operative versus nonoperative management of acute Achilles tendon rupture: systematic review and meta-analysis (2025)
- Pisano et al. (2025), systematic review and network meta-analysis, DOI: 10.1002/ksa.12686
- Early versus late weightbearing after nonoperative treatment (2022), PubMed
Editorial draft · October 2026. This information does not replace individual medical examination or advice.