Partial Achilles tears – the symptoms, healing process, and treatment

Partial Achilles tendon tears or ruptures can sometimes be difficult to diagnose correctly, and the treatment to rehabilitate your tendon back to full functionality can also be quite tricky. This article explains what the partial Achilles tear symptoms are, how the healing process works, and the elements of a good rehab programme. It also discusses whether you should consider surgery for a partial Achilles rupture.

In this article:

1. Symptoms: What you might expect from the anatomy and what a partial Achilles rupture or partial tear feels like.

2. Recovery: What happens with the healing repair of a partial Achilles rupture and how long it takes.

3. Treatment: What you can expect from the rehabilitation journey for a partial Achilles tear.

4. Whether you may need surgery for a partial rupture of the Achilles tendon.

5. How can help

We have also made a video mini-series that covers these topics. You can start watching it here.

What does a partial Achilles tear feel like?

The Achilles tendon is made up of your two calf muscles, the gastrocnemius and the soleus. They both come down your calf and turn into the Achilles tendon, which then attaches into your heel bone at the back.

A partial Achilles tear or a partial rupture means that some of the fibres that make up that Achilles tendon have been torn – not all of them, and quite often it’s only a few. So, how would you know if you had a partial Achilles rupture or a partial Achilles tear?

Normally, it causes a sudden, sharp feeling of pain. Some people describe it as feeling like being kicked in the back of the calf. This typically happens while you’re doing an activity that uses your calf muscles, for example pushing off to move, jumping, or executing explosive movements.

After the initial pang of pain, you would notice further pain when you try to contract those muscles again, for instance when you go up onto your toes, more pushing off movements or walking. You might also notice pain if you were to try and stretch that calf or the Achilles tendon.

Over a period of a few hours to maybe a day or so, you'll also notice some swelling coming out around that area where it's being torn, and this might look quite bulgy.

What to do if you suspect a partial Achilles tear

First, you want to make sure that this is a partial Achilles tear and not a complete tear. This video might guide you towards being able to tell the difference. If you’re still unsure, it's worth getting a medical opinion by getting an ultrasound scan to see what has actually happened and whether we are dealing with a partial Achilles rupture or a complete one.

Partial Achilles tear recovery

Once you have established that you do indeed have a partial Achilles tear, you may wonder whether and how it will heal and how long it might take.

How will a partial Achilles tear heal?

One of the first things that happens after a partial Achilles rupture is that your creates inflammation. This usually happens within the first few hours and peaks within the next two or three days, unless you do something that irritates the injury again. You will notice symptoms like swelling, redness, a bit of warmth, or a bulgy look to the back of the partially ruptured Achilles tendon.

That inflammation is good news! It's the first stage of healing and it's an important phase, as it is part of the process in which your body gets rid of the damaged cells. While this inflammation is happening and as it starts to subside, the body then sends a blood supply to the injured area with all of the cells that are necessary for knitting those ruptured fibres back together again.

A healthy Achilles tendon is made up of lots of bundles of fibres in straight lines. However, when torn Achilles tendon fibres knit back together, they go all higgledy-piggledy in various directions and not in straight lines. I will explain further down how this alignment becomes more parallel and how long it might take.

Partial Achilles tear healing time

This knitting back together takes a few weeks. It starts really quickly and can take up to 12 weeks. However, depending on the severity of the tear, at around about nine, ten weeks we can be relatively confident that things have knitted back together.

However, this does not mean that your tendon has regained it's previous strength after 12 weeks. After the fibres have knitted back together, the body then starts to reorganise them from the higgledy-piggledy formation back into parallel fibres, and that can take several more months. It does this through the rehab exercises (especially the strength training) you do. Without building the tendon back up to its original strength, it will remain weak and prone to re-injury.

Can Achilles tendonitis turn into a tear and influence the healing time?

Sometimes, when we look at scans of people that have had Achilles partial ruptures or partial tears, there can be signs that there was a tendonitis or tendinopathy in that tendon before. So, if you've had a grumbling tendon that's been causing you problems for a while before, or symptoms of a tendinopathy, your healing process may take a little longer, and your rehabilitation may need to include rehabilitation for a tendinopathy.

Treatment for a partial Achilles tear

It’s useful to regard a treatment or rehab programme for a partial Achilles tendon rupture as a pyramid. At the top is your goal, and this will differ from person to person. It could be anything from very active sports like running, basketball, or tennis, to walking or playing golf. And right at the bottom is the initial phase of the rehabilitation.

The initial phase of partial Achilles tear treatment

This initial or acute phase is where your Achilles is quite swollen, directly after you’ve had the accident or incident that has caused that sudden, sharp pain. So, we start off by trying to help your Achilles to have a better chance of healing. What we need to do is make sure that the torn fibres are in with a good chance of knitting their ends back together.

To do that, you need to raise your heel into a higher position than your toes, so that the edges of the torn fibres can be somewhat closer together. Ways of doing this are putting a wedge or wedges in the back of your shoe to raise up your heel or getting something more formal prescribed by a doctor.

Normally the heel is raised by a few centimetres to start with, depending on the severity of your tear. And over a period of time, as those fibres knit back together, the wedges can gradually get lower until they're gone completely.

So, the main aspect of the bottom of the pyramid is to put the partially torn Achilles tendon into a position that will help with its healing.

Other aspects of this phase are:

• If you normally do exercises to strengthen your legs, it is useful to figure out a way to continue doing at least some of those in ways that don't involve your foot or ankle. Doing squats with heels lifted can for instance work well.

• You should also be looking at swelling and what can you do for swelling management by resting and elevating your foot. There is a debate about whether applying ice packs is a good or a bad thing, as some people claim that it can inhibit the inflammation that is necessary to kick-start your healing process. Our advice would be to use ice for short periods, 10 minutes at most, if needed for pain control (as it is preferable over using medication) but don't leave it on for ages.

• It is advisable to stay away from anti-inflammatories in the first few days, because those will definitely impede the start of the healing process of your partially ruptured Achilles tendon.

Once you've got over that acute phase, you can then start doing some gentle strength exercises. Again, depending on the severity of your partial Achilles tear, this would usually start between three and six weeks after the injury.

These strength exercises usually (not always) start with contractions without any movement, and they are called isometric contractions. When your muscles have been strengthened somewhat in this way or perhaps they are strong enough from the outset, we can move to the next level of the pyramid.

Progressive strength exercises for partial Achilles tear rehab

Typically, the next level involves exercises with movement. You would be progressing on to things like calf raises, so, raising up on your tiptoes and down again. These exercises help to strengthen those freshly knitted together tendon fibres that are now gradually going from being higgledy-piggledy to running parallel to each other.

Once again, these should be phased in depending on your situation, and then gradually you would increase the amount of weight that you’re asking your injured tendon to help raise. So, you may start seated, you may start on both feet, or on one foot, depending on the severity of your injury and on the guidance of the health professional that you see.

Once you get to the point where you’re doing single leg calf raises of your full body weight with no wedges under your heel, you can be quite confident that your Achilles tendon has knitted back together and is healed.

Now, you might add weights to the calf raises, you might start using different equipment in a gym if that's the thing you like to do, or you might start doing your calf raises with a bigger range of movement over the side of a step.

Goal-specific exercises for partial Achilles tear rehab

Once you get to a point where you can do single leg calf raises with your body weight plus some weight added – how much weight will depend on your goal at the top of that pyramid – you can start adding more exercises that are specific to your goal, for example jumping, hopping, and more bouncy, plyometric type exercises that are appropriate for your age and your injury.

And then, gradually, you can phase in more sport-specific types of movement. So, for example, tennis players need to be bouncing up on their toes a lot and be able to lunge in various directions. Runners may need to be able to run uphill as well as downhill or at speed. People in ball sports like basketball or football may need to change direction suddenly while running.

Examples of such a phasing back in program might be a jog-walk program for runners, and for footballers it might be playing only a certain amount of game-time in a match or joining their squad only in certain drills at practice sessions.

As you would have gathered by now, there are many variables to play with, and there is no one-size-fits-all rehab programme for a partially torn Achilles tendon. And that's why this article cannot tell you exactly which exercises to do and in what order. It depends on you as an individual and you need to gain professional advice on that.

Some people need to go slower with the rehab and some people can go faster. Some people's pain and swelling may respond differently to different exercises, and it therefore wouldn't be safe or appropriate to give too difficult exercises to somebody in the early stage of their rehabilitation. Conversely, it wouldn't be appropriate to give too easy an exercise to people near the end of their healing process.

Read more on whether you can walk with a torn Achilles tendon.

Does a partially torn Achilles require surgery?

Surgery for a partial Achilles tear or partial Achilles rupture is really uncommon and should be a last resort. Most of these injuries get better with time, healing, and the correct rehabilitation.

Research has shown that the results of surgery for a partially torn Achilles tendon are about just as successful as those of a conservative, exercise-based rehab programme. However, with surgery there are a few additional things to think about.

First, any incision in your body, no matter how small, carries with it the risk of infection. Further, your foot and ankle will probably be immobilised for a while after surgery, for example by putting it in a special boot, and this comes with the risk of deep vein thrombosis. Your medical practitioner will, of course, take steps to try and manage these risks, but they do remain.

Also, having had surgery, you would have to follow this up with a rehab programme in any case, but this will have to wait until you have recovered from the surgery.

So, in most cases it would be better to opt for a rehab programme for a partial Achilles tear rather than for surgery.

What about surgery if you’ve been following a rehab programme but it hasn’t had the desired results? Consider whether you have been doing a generic rehab programme off the Internet or that someone well-meaning has recommended to you. Consider whether your programme has taken into account factors like:

• Your specific goals and needs

• How strong your muscles are

• How robust your tendon is

• Where you are in the healing process

• Your age and sex

• Whether you have any other medical issues that may be delaying your healing

• And if the programme progressed from low to high intensity or just remained the same.

So, if you think you've had a partial Achilles tear or rupture or you have a confirmed diagnosis, and/or you’ve been following a rehab programme without success, and you’re not sure what to do next, my suggestion would be to book an appointment with ourselves so we can assess your treatment, goals and current level of function and guide you on your specific rehab.

How we can help

Need help with your Achilles injury? You’re welcome to consult one of the team at TMA online via video call for an assessment of your injury and a tailored treatment plan.

We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Treat My Achilles we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.

About the Author:

Alison Gould is a chartered physiotherapist and holds an MSc in Sports and Exercise Medicine. You can follow her on LinkedIn, Facebook, Instagram, and Twitter.

References:

1. Gatz, M., et al. (2020). "Partial Achilles tendon rupture—a neglected entity: a narrative literature review on diagnostics and treatment options." Journal of Clinical Medicine 9(10): 3380.

2. Medeiros DM. Conservative treatment of Achilles tendon partial tear in a futsal player: A case report. Physiother Theory Pract. 2021 Oct;37(10):1158-1165.

3. Masci L., Alfredson H. Promising results using a simple rehabilitation program to treat partial ruptures in the Achilles midportion.J. Biomed. Graph. Comput. 2013;3:47