The Achilles tendon connects the large calf muscles (gastrocnemius and soleus) directly to the heel bone (calcaneus), allowing for basic movements like pushing off the foot. A tear or rupture of this structure is a severe injury, frequently occurring when the tendon is suddenly stretched beyond its capacity during activities involving forceful push-off or rapid change in direction. Understanding the immediate signs of this injury is a crucial first step in determining the necessary medical response.
Acute Symptoms of an Achilles Tear
The onset of an Achilles tendon rupture is marked by an immediate sensory experience. Many people report hearing a loud “pop” or snapping sound originating from the back of the ankle at the moment of injury. This is often accompanied by a sudden, sharp pain that can feel like a direct impact, sometimes described as being kicked or struck by a hard object in the calf.
Immediate swelling and bruising typically develop around the heel and lower calf area soon after the injury occurs. The most noticeable functional impairment is the inability to push off the foot or stand on the toes of the affected leg. Although the initial, searing pain may subside quickly, a functional deficit remains because the connection between the calf muscle and the heel bone has been broken.
Simple Home Tests for Achilles Integrity
While self-assessment is not a substitute for professional diagnosis, simple checks can help gauge the integrity of the tendon. Attempting to perform a single-leg heel raise is typically impossible with a complete rupture. This test checks the tendon’s ability to transmit force from the calf muscle to the foot.
Another indicator is the presence of a palpable gap or indentation in the tendon roughly 1 to 5 centimeters above the heel bone. Gently feeling this area of the lower calf may reveal a noticeable defect where the tendon should be continuous.
A simplified version of the Thompson Test, or calf squeeze test, can also be performed while kneeling on a chair or lying face down with the feet hanging over an edge. Squeezing the calf muscle of an intact leg causes the foot to point downward (plantar flex); if the tendon is ruptured, this squeeze will produce little or no foot movement.
Immediate First Aid and When to Seek Emergency Care
Any suspected Achilles tendon rupture requires prompt medical attention. The immediate goal is to stabilize the area using the R.I.C.E. protocol: Rest, Ice, Compression, and Elevation. Rest is achieved by immediately stopping all weight-bearing activity, as attempting to walk can worsen the separation of the tendon ends.
Ice should be applied to the area for about 15 to 20 minutes at a time to help manage swelling and pain. Compression using an elastic wrap can help reduce swelling, but the wrap must not be applied so tightly that it restricts circulation. Elevating the ankle above the level of the heart assists gravity in draining excess fluid and minimizing swelling. This injury requires evaluation within 24 to 48 hours to determine the best course of treatment.
Professional Diagnosis and Recovery Overview
The diagnosis is typically confirmed through a clinical examination, which includes the formal Thompson Test. This physical assessment is highly accurate for complete ruptures but is often followed by imaging to confirm the extent of the tear. Ultrasound is a common, fast, and non-invasive imaging method used to locate the tear and measure the gap between the tendon ends.
Magnetic Resonance Imaging (MRI) is often used for a more definitive assessment, particularly if a partial tear is suspected, as it provides high-resolution images of the soft tissues. Treatment paths include non-surgical management involving long-term immobilization in a cast or boot, or surgical repair to stitch the torn ends back together.
The choice between these options depends on factors such as the patient’s age, activity level, and the specific characteristics of the tear. Regardless of the initial treatment choice, a lengthy rehabilitation period is necessary, typically involving physical therapy for six months or more to fully regain strength and function.