The Achilles tendon is the largest and strongest tendon in the human body, connecting the calf muscles to the heel bone at the back of the lower leg. It transmits the force necessary to push off the foot, enabling walking, running, and jumping. Injuries are common, especially in active individuals. A significant source of confusion is the difference between a “ruptured” and a “torn” Achilles, terms often used interchangeably despite having distinct technical meanings.
Terminology Explained: Rupture Versus Tear
In the context of tendon damage, “tear” is a broad term describing any injury where the tendon fibers are damaged or separated. A tear can be partial, meaning only some fibers are damaged, or complete, where the tendon is severed all the way through.
A “rupture” technically implies a complete separation or a full-thickness tear of the tendon fibers. This means the connection between the calf muscles and the heel bone is entirely broken. While the general public uses both words, a rupture is always a complete tear, and in clinical practice, “rupture” and “complete tear” are functionally equivalent.
Recognizing the Injury
A rupture typically occurs during sudden, forceful movements, such as a rapid push-off, an abrupt stop, or an unexpected change in direction. The injury often involves an eccentric load, where the calf muscles contract strongly while the foot is forced upward, stressing the tendon beyond its capacity.
The immediate symptoms are classic. The individual frequently reports hearing a distinct, loud “pop” or snapping sound as the tendon fibers separate. This is followed by severe, sharp pain in the back of the ankle, often described as feeling suddenly kicked or struck hard in the heel.
This pain is quickly followed by a profound functional deficit. A person with a complete rupture cannot stand on their toes on the injured side because the push-off connection is compromised. Diagnosis is often confirmed by a physical examination, such as the Thompson test, where squeezing the calf muscle fails to make the foot point downward.
Treatment Pathways
Treatment for a ruptured Achilles tendon contrasts two main approaches: surgical repair or non-surgical management. The decision depends on the patient’s age, physical activity level, and the injury’s severity. Younger, highly active individuals often choose surgery to maximize the potential for full strength recovery.
Surgical repair involves stitching the two torn ends of the tendon back together to restore accurate length and tension. This approach is favored because it is associated with a lower rate of re-rupture, a major concern for active patients. Potential complications include the risks of infection and nerve damage.
Non-surgical management involves immobilizing the ankle in a cast or specialized walking boot, with the foot pointed downward to promote healing. This conservative method is often chosen for older, less active individuals or those with health conditions that make surgery risky. Recent non-surgical protocols incorporate early functional rehabilitation with controlled movement.
The Road to Recovery
Full recovery, regardless of whether treatment was surgical or non-surgical, requires a structured rehabilitation program. The initial phase focuses on protecting the healing tendon, often by keeping the foot pointed down to reduce tension on the repair site. This is followed by a gradual process of restoring the normal range of motion in the ankle.
The later stages of physical therapy concentrate on rebuilding the strength and endurance of the calf muscles, which atrophy during immobilization. Exercises progress from simple resistance band movements to standing heel raises and eventually to dynamic activities like jumping and running. A full return to high-impact sports typically takes six to twelve months.