The Achilles tendon is the largest tendon in the human body, connecting the calf muscles to the heel bone. It is responsible for plantar flexion, the action of pointing the toes downward, which is necessary for pushing off the ground during walking, running, and jumping. A tear to this tendon is a severe injury that immediately compromises the ability to move the foot and ankle. Because the Achilles tendon bears immense load, a tear significantly limits mobility and requires immediate medical attention.
Walking Capability Based on Injury Severity
Walking capability after an Achilles tear depends entirely on the extent of the damage. A partial tear involves damage to only some fibers, meaning the connection between the calf muscle and the heel bone remains functionally intact. Walking with a partial tear is physically possible but causes significant pain and an altered gait, such as limping, as the person avoids pushing off the foot.
A complete tear, or rupture, severs the tendon entirely, separating the calf muscle from the heel bone. In this scenario, normal walking becomes functionally impossible because the mechanism for push-off is lost. Walking is reduced to a flat-footed shuffle, as the calf muscles cannot generate the force needed to propel the body forward. The inability to stand on the toes of the injured foot is a clear indicator of a complete rupture.
Immediate Actions Following a Suspected Tear
A sudden pop or sharp pain in the back of the ankle often signals an Achilles tear. Urgent self-care must focus on protecting the injured area by following the R.I.C.E. protocol. It is imperative to seek professional medical evaluation immediately after the injury.
The R.I.C.E. protocol includes:
- Rest: Avoid all weight-bearing activity on the injured limb to prevent further damage and separation of the tendon ends.
- Ice: Apply ice for 15 to 20 minutes at a time, using a barrier to protect the skin, which helps reduce swelling and pain.
- Compression: Use an elastic bandage to minimize swelling, ensuring it is not wrapped so tightly that it causes numbness or tingling.
- Elevation: Raise the ankle above the level of the heart to help drain excess fluid from the injury site.
How Doctors Confirm an Achilles Tear
Diagnosis begins with a physical examination of the lower leg, checking for tenderness, swelling, and a palpable gap in the tendon above the heel bone. The primary clinical method to confirm a complete rupture is the Thompson Test, or calf squeeze test.
During the Thompson Test, the patient lies face down. When the doctor squeezes the calf muscle of an uninjured leg, the foot points downward (plantar flexion). If the Achilles tendon is completely torn, squeezing the calf muscle produces little to no movement in the foot, indicating a positive test. Imaging, such as ultrasound or Magnetic Resonance Imaging (MRI), is used to confirm the extent of the tear, measure the gap between the tendon ends, and distinguish between a partial tear and a complete rupture.
Recovery Paths and Expected Timelines
Non-Surgical Management
The non-surgical approach typically involves immobilizing the foot in a boot or cast for several weeks, often with the foot pointed downward to allow the tendon ends to heal closer together. This method is often chosen for older, less active individuals or those with partial tears. Modern protocols encourage early, controlled weight-bearing during this phase.
Surgical Repair
Surgical repair involves stitching the torn ends of the tendon back together. This option is generally favored by younger, active individuals because it results in a lower risk of re-rupture. While surgery carries risks like infection and wound healing issues, it often facilitates a faster return to full strength.
Rehabilitation and Timeline
Regardless of the initial treatment, physical therapy is fundamental to recovery, focusing on restoring range of motion, flexibility, and strength. Early phases involve gentle motion, followed by progressive strengthening exercises like calf raises. Patients typically remain in a boot or cast for six to twelve weeks. A return to walking without support occurs gradually after immobilization. Full recovery and a return to sports or high-impact activities can take six to twelve months, depending on the individual’s progress.