Achilles Ruptures

The Achilles tendon is the rope-like band at the back of the ankle that lets you push off the ground when you walk, climb stairs, or run. A rupture tears it completely, usually a few centimeters above the heel where the blood supply is poorest. The two ends snap apart and retract, leaving a gap, and you can no longer rise up on your toes. Most ruptures happen during a sudden push-off, and the risk is highest in middle-aged adults returning to sport after time off. The tendon does not heal on its own without support, but with the right treatment it heals reliably and most people return to their normal activities.

Common symptoms include:

• A sudden, loud pop and sharp pain at the back of the leg
• An inability to rise up onto the toes of that foot
• Walking flat-footed but losing push-off strength
• Swelling and bruising at the back of the ankle within a few hours
• A small gap that can be felt above the heel

A focused physical exam, the gap that can be felt above the heel, and the inability to rise onto the toes usually make the diagnosis on the day you come in. Ultrasound in the clinic confirms the tear and measures the gap between the ends, which helps decide between treatment paths. MRI is reserved for complex or partial-tear cases.

The two torn ends can heal back together without surgery when they are held in close contact while the tendon knits:

• A cast holding the foot pointed downward to bring the ends together
• A progressive boot with heel wedges that are gradually removed
• Physical therapy to rebuild strength and range of motion

This path often suits older or lower-demand patients and those without a wide gap. Surgery stitches the two ends back together and is generally preferred for younger, more active patients and for wide-gap ruptures, with a lower re-rupture rate.

• Achilles tendon repairFoot & Ankle

For a fuller explanation, including anatomy, diagnosis, and the full range of treatment:

• Achilles Tendon Rupture (Tear) — AAOS OrthoInfo