The Achilles tendon is the largest and strongest tendon in the body, connecting the powerful calf muscles to the heel bone (calcaneus). Its function is to facilitate plantarflexion, the downward pointing of the foot, which is the mechanical action required to push the body off the ground, stand on the toes, and propel forward during walking or running. A tear in this structure, ranging from a partial strain to a complete rupture, is a severe injury that immediately compromises the primary propulsion system of the leg.
The Impact on Mobility
The ability to walk after an Achilles tendon tear depends significantly on the severity of the injury, but true walking becomes severely compromised or impossible. Walking requires the calf muscles to contract and pull on the Achilles tendon to lift the heel off the ground, known as the “push-off” phase of the gait cycle. Without the tendon’s structural integrity, this essential propulsive force is lost.
In the case of a complete rupture, the connection between the calf muscle and the heel bone is entirely severed, making a normal push-off virtually impossible. Some individuals may still manage to put weight on the foot and ambulate with a heavily altered gait, relying on hip and thigh muscles for compensation. However, this is not true walking but rather a painful, unstable shuffle that avoids placing strain on the injured mechanism.
A partial tear, where only some of the tendon fibers are damaged, allows for limited movement, though it is often accompanied by significant pain. The remaining intact fibers may transmit enough force to permit a painful limp or allow the person to bear weight, though with severely limited power and stability. Since the tendon is compromised, standing on the toes of the injured leg becomes impossible in both partial and complete tears, which is a tell-tale sign of the injury.
Identifying the Symptoms of a Tear
An Achilles tendon tear is often accompanied by a distinct set of immediate sensory and physical signs. Many people report hearing or feeling an audible “pop” or “snap” at the moment the injury occurs, a sensation often described as feeling suddenly kicked or struck hard in the back of the ankle.
Following this sudden event, severe and sharp pain immediately localizes near the heel and lower calf, typically followed by noticeable swelling in the area. A physician may also be able to palpate a distinct gap or depression in the contour of the tendon, which indicates where the rupture has occurred. The inability to stand on the ball of the foot or raise the heel off the floor on the affected side is a clear functional symptom.
First Aid and Medical Evaluation
Immediate care for a suspected Achilles tear should focus on stabilizing the injury and reducing swelling using the R.I.C.E. protocol. Rest is paramount, meaning all weight-bearing activity must cease immediately to prevent further damage to the compromised tendon. Applying ice to the area helps to minimize inflammation and pain, while gentle compression with a soft bandage can also reduce swelling.
Elevating the foot above the level of the heart further assists in draining excess fluid from the injured tissue. While these first-aid measures are helpful, seek professional medical attention promptly, as a timely diagnosis is necessary to determine the appropriate treatment course.
At the clinic, a physician will typically perform the Thompson Test, a highly accurate physical diagnostic tool. During the test, the patient lies face down while the doctor gently squeezes the calf muscle. If the Achilles tendon is intact, this squeeze causes the foot to automatically point downward (plantarflexion). An absence of this foot movement indicates a positive test result and confirms a complete tear, as the force from the calf squeeze cannot be transmitted to the heel. Imaging, such as an ultrasound or MRI, may also be used to confirm the diagnosis, visualize the exact location of the tear, and measure the gap between the torn ends.
Choosing a Treatment Course
Treatment for an Achilles tendon tear generally follows one of two main pathways: surgical repair or non-surgical management. Surgical repair involves stitching the torn ends of the tendon back together, which is often recommended for younger, highly active individuals. This option typically results in a lower risk of the tendon re-rupturing compared to non-surgical methods.
Non-surgical management involves immobilizing the foot and ankle in a cast or specialized boot to allow the tendon to heal naturally. This conservative approach is often preferred for older patients, those with lower physical demands, or those with health conditions that make surgery risky. Modern non-surgical protocols frequently incorporate accelerated functional rehabilitation, which uses early mobilization to support healing. The final decision depends on a thorough evaluation of the tear’s severity, the patient’s lifestyle, and their personal recovery goals.