If you suspect a rupture: get into plantar flexion now
Keep your toes pointing downward (toes-down) and immobilize in a boot with heel wedges or a splint. Avoid walking flat-footed or stretching the ankle upward.
Recognize the Symptoms
Common Signs of an Achilles Rupture
Confirm what you’re feeling before you move.
Sudden sharp pain in the back of the ankle or calf (often feels like being kicked).
Pop or snap heard or felt at the time of injury.
Immediate weakness or inability to push off your foot.
Swelling and bruising around the heel and ankle.
Difficulty on tiptoes or walking with a normal push-off.
Immediate Next Steps
Protect the Tendon in the First 24–48 Hours
Keep the tendon ends approximated and swelling controlled.
Rest
Avoid weight-bearing on the injured side; use crutches if available.
Ice
15–20 minutes every 2–3 hours. Wrap ice — no direct skin contact.
Compression
Elastic wrap or boot liner to limit swelling (not too tight).
Elevation
Foot above heart level whenever resting.
When to See a Doctor
Don’t Wait — Same-Day Assessment Is Best
Urgent care or emergency department is appropriate.
Seek care immediately if you:
- Felt/heard a pop and now have weakness or severe pain.
- Cannot push off or stand on your toes.
- Have swelling/bruising and a “floppy” ankle sensation.
Causes & Risk Factors
Why It Happens
Usually a sudden overstretch during explosive movement.
Common Triggers
- Jumping, sprinting, sudden stop/start sports (basketball, soccer, tennis).
- Unexpected push-off (e.g., stepping off a curb).
- Returning to intense activity after inactivity.
Risk Factors
- Men ages 30–50; “weekend warrior” patterns.
- Tight/weak calves or prior tendon issues.
- Fluoroquinolone antibiotics or corticosteroid injections.
- Obesity and chronic overuse.
What to Expect at Diagnosis
The Evaluation Process
Physical Examination
Palpation for tendon gap, range-of-motion check, and the Thompson test (calf squeeze to see if the foot plantarflexes).
Imaging (if needed)
Point-of-care ultrasound or MRI can help confirm partial vs. complete rupture and guide treatment.
Treatment Planning
Based on severity and activity level, you’ll discuss non-surgical boot protocol vs. surgical repair. Both paths require rehabilitation.
Early Comfort Tips
At-Home Care
• Elevate the leg on pillows above heart level.
• Ice regularly (wrapped) to control swelling.
• Take pain meds as prescribed.
• Avoid heat or massage for the first 72 hours.
• Sleep with the foot slightly elevated.
Mobility Tips
• Use crutches; avoid weight-bearing unless instructed.
• Consider a knee scooter for easier mobility.
• Keep the boot/cast clean and dry.
• Follow your clinician’s weight-bearing timeline.
• Clear pathways at home for safe movement.
What Happens After Diagnosis
The Standard Recovery Journey
Follow this evidence-based timeline for optimal healing. Every person's recovery is unique, so work closely with your healthcare team to adjust as needed.
Initial Protection
Protect the tendon with boot and heel lift while beginning safe movement.
- Aircast boot with 2 cm heel lift
- Weight Bearing As Tolerated (WBAT) with crutches as needed
- Elevation and swelling control
- Gentle non-weight-bearing/upper body activity
Early Mobilization
Begin gradual weight bearing, mobility, and light strengthening.
- Continue Aircast boot with heel lift (wean as advised)
- WBAT with crutches as needed
- Light hip and knee strengthening
- Non-weight-bearing cardio (bike, pool without push-off)
- Swelling control and gentle mobility
Strengthening Phase
Progress strength, flexibility, and proprioception under guidance.
- Wean out of boot
- Gentle dorsiflexion stretching
- Progressive strengthening (bands, closed/open chain, functional)
- Proprioception and gait retraining
- Cardio: cycling, swimming, hydrotherapy
Return to Activity
Gradual return to sport and full functional recovery.
- Transition to normal walking and jogging
- Advance ROM, strength, and balance
- Sport-specific drills and plyometrics
- Clearance for full activity
Important: Always consult with your healthcare provider before advancing between stages.