A suspected rupture of the Achilles tendon is a serious musculoskeletal injury demanding immediate professional medical evaluation. This strong, fibrous cord connects the calf muscles to the heel bone. A complete tear fundamentally compromises the ability to push off the foot, which is essential for walking. Seeking immediate care is the first step to prevent long-term functional deficits.
The Immediate Physical Capacity After Rupture
A person cannot walk normally on a completely ruptured Achilles tendon because the main connection required for the powerful push-off phase of gait is severed. The Achilles tendon, formed by the gastrocnemius and soleus muscles, is the primary engine for plantarflexion (pointing the foot downward). Despite this loss, limited, awkward movement remains possible due to smaller intact muscles, such as the plantaris and tibialis posterior. This compensatory action allows a person to stand and place the foot down, resulting in an abnormal, flat-footed, or shuffling gait. Attempting to walk on a ruptured tendon is strongly discouraged because it can separate the torn ends further, complicating surgical repair and increasing recovery time.
Recognizing the Signs of a Ruptured Achilles
The onset of an Achilles rupture is typically a dramatic event, accompanied by distinct and immediate symptoms. Many people report hearing or feeling a sudden, loud “pop” in the back of the ankle, often described as the sensation of being kicked or shot. This acute event is followed by intense, sharp pain in the lower calf or heel area. A physical examination often reveals a palpable gap or depression in the tendon above the heel bone. The most reliable clinical assessment is the Thompson Test, where squeezing the calf muscle fails to produce the expected downward movement of the foot, confirming the broken connection.
Initial Medical Intervention and Treatment Decisions
Following diagnosis, initial intervention focuses on immobilizing the ankle in slight plantarflexion to bring the torn tendon ends closer, typically using a cast or specialized boot. The decision between non-surgical management and surgical repair is tailored to the individual’s age, activity level, and overall health. Surgical repair is often favored for younger, highly active individuals seeking a return to high-impact sports. This approach offers a lower re-rupture rate, which is typically reported around 2.3% to 3.5%.
However, surgery carries inherent risks, including a higher complication rate, primarily due to wound infection (up to 6%). Non-surgical management involves prolonged immobilization, gradually moving the ankle from a pointed position to neutral over several weeks. This option is preferred for older, less active patients or those with health conditions like diabetes that complicate wound healing. While traditional non-surgical methods had a higher re-rupture rate, modern protocols have significantly lowered this risk, balancing the lower re-rupture risk of surgery against the lower complication risk of non-surgical treatment.
Rehabilitation Phases and Full Recovery Timeline
The rehabilitation process is a lengthy, multi-phase commitment beginning immediately after initial treatment. The first phase focuses on protected healing, involving non-weight-bearing or restricted weight-bearing in a boot for four to twelve weeks. The intermediate phase transitions the patient to full weight-bearing, focusing on regaining range of motion and initiating strengthening exercises. Physical therapy is instrumental in preventing the tendon from healing in an elongated position, which would compromise strength.
As healing progresses, the program introduces controlled loading, often including seated calf raises. A crucial component of the later phase is eccentric exercise, which involves slowly lengthening the calf muscle under tension to build tensile strength and endurance. A realistic timeline for returning to an unassisted walking pattern is typically three to five months. Full recovery, including a return to sports or vigorous activities, requires six to twelve months or longer, dependent on meeting specific strength and balance criteria.