Everyone's pain threshold is different, but it's common for Achilles tendon tears—especially Achilles tendon ruptures—to be extremely painful. It may also be hard to walk or perform other daily activities.
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What is a ruptured Achilles tendon?
Movement, especially athletic activity, puts pressure on the Achilles tendon, the tendon on the back of your leg that connects the heel to the calf. When stressed beyond its limits, this tendon can tear, or rupture, meaning you’ve damaged the fibers that make up the tendon. Rupture is a term commonly used to describe a complete and severe tear. Achilles tendon tears vary in severity from a partial tear to a complete rupture and are classified into three grades. The severity or grade of the tear determines your symptoms, treatment options, and recovery time.
The Achilles tendon is the largest tendon in the body. It plays an essential part in many movements, so a tear or rupture can impede your ability to train and perform daily activities. Getting proper treatment is essential to recovering from a torn Achilles tendon.
Causes and grades of Achilles tendon tears
An Achilles tendon tear can occur in any athletic activity where the athlete is running or jumping. The injury usually occurs about two inches from where the tendon connects to the heel bone, potentially because less blood reaches this area.
Common causes of an Achilles tendon tear during athletic activity include:
- A sudden stop or start that puts increased stress on the Achilles tendon
- A traumatic twist or pivot can stretch an Achilles tendon to the point of tearing
Achilles tendon tears are common in soccer, basketball, tennis, squash, pickleball, and football. They’re most likely to occur during high-intensity activity after a long period without regular training, like an impromptu game of basketball after years off the court. The severity of the rupture is classified into one of three grades:
- Grade 1: A mild injury that brings minimal torn tendon fibers, known as a partially torn Achilles
- Grade 2: When less than half the Achilles tendon fibers tear
- Grade 3: Considered a full rupture when the majority or all the fibers tear
Depending on the severity of the injury, your doctor may choose surgical or non-surgical options to treat an Achilles tendon rupture.
Torn Achilles symptoms
When the Achilles tendon tears, you may hear or feel a "popping" in the heel. After the initial injury, common Achilles tendon rupture symptoms include:
- Pain around the Achilles tendon area (back of the heel)
- Swelling and thickening of the tendon
- Instability and difficulty walking, especially on an incline or decline
- Tenderness at the point of injury
- Increased pain and stiffness with use
Who is most at risk for an Achilles tendon rupture?
Age, gender, and physical condition all contribute to the likelihood of a ruptured Achilles tendon:
- Age: Achilles tendon ruptures are most common in your 30s and 40s.
- Gender: Men are five times more likely to rupture an Achilles tendon than women.
- Physical condition: Regular training strengthens the Achilles tendon, reducing the risk of an Achilles tendon tear. Infrequent sports participation increases risk by encouraging brief, high-intensity movements in an unprepared athlete.
- Weight: Being overweight or obese places additional stress on the Achilles tendon.
- Medications: Tendons can weaken with some medications, such as specific antibiotics and steroid injections.
How do you prevent Achilles tendon rupture?
There's no way to completely prevent sudden athletic injuries. However, reducing risk factors can help lower the chance of rupturing your Achilles tendon. Here's how you can help your Achilles tendon stay in the best possible condition:
- Maintain a consistent intensity level. A sudden jump from no activity to high intensity can overstress the tendon.
- Strengthen and stretch your calf muscles to ensure they can help the Achilles tendon handle the extra stress.
- Warm up before activities and increase activity gradually.
- Exercise on even surfaces and wear proper footwear.
- Reduce stress on the Achilles tendon by rotating athletic activities and limiting high-impact activities.
Treatment for a ruptured Achilles tendon
Treatments for Achilles tendon injuries vary with the severity of the damage. For example, mild grade 1 tears may be able to heal with time and rest, while grade 3 tears almost always require surgery to fix. When possible, your surgeon will perform a minimally invasive procedure that repairs the tear with only a few small incisions to insert the operating instruments.
Call 617-726-0500 or request an appointment with a Mass General Brigham sports medicine specialist.
FAQs about Achilles tendon tears
The difference between a torn and ruptured Achilles is severity. An Achilles tear can describe any Achilles tendon injury where the fibers have torn (grades 1-3), while “ruptured Achilles” is typically used only to describe grade 3 tears.
A rupture typically refers to a grade 3 tear (the most severe of the three tear grades), when most of the tendon is torn.
A torn Achilles tendon needs to be treated to heal properly. Left untreated, it may heal poorly or incompletely, resulting in loss of strength and mobility.
With a partial Achilles tendon tear, you may feel a sensation like being kicked or hit in the back of the ankle when the injury occurs. Afterward, you can expect pain and possibly bruising and swelling in the back of your ankle. The pain will be more pronounced during walking, running, and jumping.
Not usually. An Achilles tendon rupture is an acute, traumatic injury. That means it is typically the result of an accident or injury, so there may not be any warning.
Yes, you can often walk with a torn Achilles tendon, although it may cause pain. However, continuing to use a torn Achilles tendon isn't a good idea. Consult your doctor as soon as possible if you think you may have ruptured your Achilles tendon.
Achilles tendon surgery is usually either done via open surgery or percutaneously, using several small incisions to reach the tendon and reattach it. Recovery can take four to six months.
If proper treatment protocols are followed, the typical recovery time for an Achilles tendon rupture can take four to six months.
