The Achilles tendon is the largest and strongest tendon in the human body, connecting the calf muscles to the heel bone. It is fundamental to movement, transmitting force from the calf muscles to the foot to enable pushing off, walking, running, and jumping. People often use the terms “ruptured Achilles” and “torn Achilles” interchangeably when searching for information on this injury. While these phrases are often treated as synonyms, “rupture” typically implies a more severe injury compared to a general “tear.”
Clarifying the Terminology: Tear, Rupture, and Severity
The word “tear” is the broader term for any injury where the tendon fibers are damaged or separated, and its severity determines the treatment plan. The primary distinction is between a partial tear and a complete tear, with a complete tear typically referred to as a “rupture.”
A partial tear involves damage to only some tendon fibers, leaving the structure weakened but still mostly intact. A complete tear, or rupture, means the tendon has separated entirely, breaking the connection between the calf muscles and the heel bone. These severe injuries commonly happen when the tendon is stretched beyond its limit during sudden, forceful push-off movements, such as accelerating in sports like basketball or tennis.
Recognizing the Signs of Injury
A traumatic Achilles injury is often accompanied by an immediate, sharp pain, frequently described as feeling kicked or struck hard in the back of the ankle. This intense feeling is often followed by a loud, audible “pop” or snapping sound, indicating the tendon fibers are separating.
Although the initial severe pain can quickly subside, the injury immediately impairs function. It becomes difficult or impossible to stand on the toes of the injured leg. Swelling and bruising around the heel and lower calf are also common following the initial trauma.
Confirming the Diagnosis
Physicians rely on a thorough physical examination and specific diagnostic tests to confirm an Achilles injury and determine its extent. The most definitive physical test is the Thompson Test, which assesses the continuity of the tendon. In this test, the patient lies face down while the physician squeezes the calf muscle of the injured leg.
If the Achilles tendon is intact, squeezing the calf muscle causes the foot to point downward. If the tendon is completely ruptured, squeezing the calf produces little or no foot movement, confirming a complete tear.
Imaging studies are often used to visualize the injury, with ultrasound being a preferred method due to its ability to show the tendon in real-time. MRI is typically reserved for cases requiring a detailed anatomical map for surgical planning or when the distinction between a partial and complete tear remains unclear.
Treatment Pathways and Recovery
Treatment depends on several factors, including the tear’s severity, the patient’s age, health, and desired physical activity level. Treatment generally follows two primary pathways: non-surgical management or surgical repair. Non-surgical, or conservative, management is often considered for older, less active individuals or for partial tears where the tendon’s functional integrity is preserved.
This conservative pathway involves immobilizing the ankle, typically with a cast or specialized walking boot, allowing the tendon ends to approximate and heal naturally. Immobilization is followed by a gradual physical therapy program to regain strength and mobility.
Surgical repair is generally recommended for complete ruptures in younger, active individuals who require a full return to high-demand activities. The goal of surgery is to physically reconnect the separated tendon ends, often by suturing them together, which may reduce the risk of re-rupture and improve push-off strength. Surgery carries inherent risks, including infection, nerve irritation, and wound healing complications.
Regardless of the treatment method, recovery from a significant Achilles injury is an extended process. Patients must commit to a lengthy rehabilitation phase, often spanning six to twelve months, where physical therapy restores the tendon’s strength, flexibility, and endurance.