The Achilles tendon connects the calf muscles to the heel bone, providing the powerful push-off necessary for walking, jumping, and running. A tear, whether partial or complete, immediately compromises this mechanism. You cannot run on a torn Achilles tendon. Attempting to run on an injured tendon risks converting a partial tear into a full rupture, which significantly complicates repair and jeopardizes long-term recovery.
Understanding the Severity of an Achilles Tear
An Achilles injury is categorized based on the extent of fiber damage, ranging from a partial tear to a complete rupture. A partial tear involves damaged tendon fibers, but the tendon remains mostly continuous and functional, though severely weakened. A complete rupture means the tendon has been severed, separating the calf muscle from the heel bone.
Symptoms often provide immediate clues to the injury’s severity. Many people describe a sudden, sharp pain accompanied by an audible “pop” or the sensation of being kicked or struck in the calf.
Following the injury, there is usually significant swelling and bruising around the heel and lower leg. A rupture results in the inability to perform a forceful push-off, making it impossible to stand on the toes of the injured foot. In some cases, a clinician can feel a gap or defect in the tissue just above the heel bone.
Immediate Steps Following the Injury
Immediate management focuses on preventing further damage and controlling the initial inflammatory response. The first step is to cease all weight-bearing activity and apply the RICE protocol: Rest, Ice, Compression, and Elevation. Resting the limb prevents the calf muscles from pulling on the damaged tendon.
Applying ice for 15 to 20 minutes helps limit inflammation and swelling. Compression with an elastic bandage supports the area, and elevating the foot above heart level reduces fluid accumulation. Seek professional medical evaluation immediately, typically with an orthopedic specialist. A physician will often perform the Thompson Test, where lack of foot movement when squeezing the calf indicates a complete rupture.
Navigating Treatment Options
Once an Achilles tear is diagnosed, the patient and physician decide between two primary treatment pathways: surgical repair or non-surgical management. This decision is highly individualized, depending on factors like the patient’s age, pre-injury activity level, and lifestyle demands.
Non-surgical management involves immobilizing the ankle in a cast or functional brace with the foot pointed downward to allow the tendon ends to approximate and heal naturally. This approach is often reserved for partial tears, older individuals, or those with lower physical activity demands, as it carries a lower risk of complications like infection or wound issues. Non-operative management has historically been associated with a slightly higher re-rupture rate.
Surgical repair involves suturing the torn tendon ends together, either through a traditional open incision or minimally invasive techniques. Surgery is generally recommended for younger, high-demand athletes who prioritize returning to a high level of sport, as it results in a lower re-rupture rate. Surgery carries an increased risk of complications, including wound infection, nerve irritation, and deep vein thrombosis. Modern protocols, whether surgical or non-surgical, increasingly incorporate functional bracing and early mobilization to achieve comparable outcomes and strength, narrowing the gap in re-rupture rates.
The Structured Path Back to Running
The path back to running is a multi-phase rehabilitation process guided by specific functional milestones, regardless of whether the tear was managed surgically or non-surgically. The initial phase focuses on protection and controlled mobilization, gradually transitioning the ankle from non-weight-bearing to full weight-bearing in a protective boot over six to ten weeks. During this time, the focus is on maintaining range of motion and preventing muscle atrophy.
Restoring Strength
The next phase involves restoring fundamental strength, particularly the plantar flexors, through progressive resistance exercises like seated and standing heel raises. Full return to activities like jumping and running is contingent on achieving strength symmetry, measured by the ability to perform a single-leg heel raise with no pain or asymmetry compared to the uninjured side.
Plyometric Training
Specialized plyometric training is required to restore the tendon’s ability to store and release energy. Plyometrics, such as hopping and jumping drills, are introduced only after a sufficient strength base is established. The entire process, from injury to physician clearance for a gradual return-to-run program, typically spans six to twelve months.