Accessibility Tools

Todd Borenstein MD

Schedule Consult

Acute Achilles Tendon Rupture

What is an Achilles tendon rupture?

The Achilles tendon is the strongest tendon in the body. It connects the calf muscle to the heel, and helps control the function of the foot during activity. Achilles tendon ruptures typically occur in middle aged athletes during strenuous activities that involves running, jumping, pivoting and change of direction. Sports that involve quick changes of direction like basketball, soccer, and tennis may put patients at risk for Achilles tendon ruptures.

What causes an Achilles tendon rupture?

The Achilles tendon is subject to 2-3 times body weight force during walking, and 7-8 times body weight force during running. During a change of direction, the calf will generate very large tensile forces in the Achilles tendon that can be responsible for creating the tendon rupture. In patients in theirs 30’s, 40’s and 50’s, age related tendon degeneration may also weaken the tendon, predisposing it to tendon rupture.

What are the symptoms of an Achilles tendon rupture?

At the time of injury, many patients experience the feeling of “being struck in the back of the ankle” only to realize that no one was around them. Patients will notice immediate pain, as well as swelling in the back of the ankle and bruising. Many patients will not be able to walk, or will walk with a marked limp.

How is an Achilles tendon rupture diagnosed?

Achilles tendon ruptures are diagnosed by medical history and thorough physical examination. Often there is a palpable defect in the Achilles tendon at the rupture site. A Thompson test will be performed. This involves placing the patient on their stomach and gently squeezing the calf. If the Achilles is intact, there will be flexion of the foot. If the Achilles is ruptured, the foot will not move when the calf is squeezed. MRI is typically not indicated for the diagnosis of an Achilles tendon rupture.

How is an Achilles tendon rupture treated?

Achilles tendon ruptures can be treated very successfully with both operative and non-operative treatment.


Nonsurgical treatment of an Achilles tendon rupture entails wearing a splint and special brace to allow the tendon to heal at its normal tension. Physical therapy is recommended to help improve strength and range of motion. Non-operative treatment is preferable in patients with vascular disease, diabetes and smokers in order to avoid possible surgical complications such as wound healing problems and infections.


Surgical treatment involves suturing the torn tendon ends together. Surgery is associated with a faster recovery and lower tendon re-rupture rate, and for this reason is often recommended in younger and more active patients.