Signs and Symptoms
Common signs of an Achilles rupture include:
- A sudden pop or snap at the back of the ankle
- Sharp pain at the back of the heel or calf, which may ease quickly
- Swelling and bruising above the heel
- Trouble walking normally, pushing off or rising onto your toes on the injured side
- A gap you can feel in the tendon just above the heel
Some people can still walk after a rupture, so being able to walk does not rule it out.
What Causes It?
Ruptures most often occur in recreational athletes in their 30s to 50s during sports with sudden starts and stops, such as tennis, pickleball, basketball and soccer. Risk factors include a sudden increase in training, prior Achilles tendon pain (tendinopathy), tight calves, certain antibiotics called fluoroquinolones, and steroid injections near the tendon.
How We Diagnose It at POPB
Diagnosis is usually made with a physical exam. Your physician checks for a gap in the tendon and performs the Thompson test: squeezing the calf while you lie face down. If the foot does not point downward, the tendon is likely torn.
Dr. Adelman can use diagnostic ultrasound in the office to see the tear and how far apart the tendon ends are, which helps guide treatment. X-ray and MRI are available on site when needed. Early evaluation matters, because treatment decisions should be made soon after the injury.
Non-Surgical Treatment Options
For many people, non-surgical treatment with early functional rehabilitation is a well-supported option. It typically includes:
- A walking boot with heel wedges that hold the foot pointed down so the tendon ends stay close together
- Protected weight-bearing that progresses on a set schedule
- Gradual removal of the heel wedges over several weeks
- Physical therapy in our office to restore motion, calf strength and balance, with therapists who share your chart with your physician
Non-surgical care avoids surgical risks such as wound problems. Your physician will discuss how it compares with surgery for your age, activity level and injury.
Surgical Options
Surgical repair may be considered for some patients, such as highly active athletes, people whose tendon ends stay far apart, or injuries that were diagnosed late. If surgery is recommended, our team discusses your options with you and coordinates your care, including referral and rehabilitation afterward.
Recovery
Recovery takes time whether or not you have surgery. Most people are in a boot for roughly eight to ten weeks, followed by several months of strengthening. Return to running and jumping sports often takes six months to a year. Calf strength may remain somewhat reduced, and timelines vary with the injury and your goals.
Insurance and Cost
Evaluation, imaging, bracing and physical therapy for an Achilles rupture are generally covered by Medicare and most commercial PPO plans. Some plans limit the number of therapy visits or require authorization. HMO and managed-care plans need a referral in our office before your visit. If the injury happened at work, we accept workers' compensation. Our staff verify benefits when you call.
When to Be Seen
Call our office as soon as possible, ideally within a few days, if you felt a pop at the back of your ankle or cannot push off normally. Early diagnosis keeps all treatment options open.
Go to the emergency room or call 911 if the foot looks deformed, you cannot bear any weight, or the foot becomes cold, pale or numb. While you are in a boot, call our office the same day about calf swelling that keeps increasing, and call 911 for sudden shortness of breath or chest pain.
