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Red flags and tests for Achilles tendon ruptures and tears

If you suspect that you’ve ruptured or torn your Achilles tendon, it is very important to see a doctor as soon as possible. In this article, we explain the tests for Achilles tendon ruptures and tears that we use in our clinic and the red flags we look out for. We also discuss what scans are used to finally confirm the diagnosis of an Achilles rupture or tear. Remember, if you need more help with an Achilles injury, you're welcome to consult one of our team via video call.


Use these tests to see if you've torn or ruptured your Achilles tendon.

The terms tendinitis, tendonitis, tendinosis, and tendinopathy mean the same thing for all practical purposes, and we use these interchangeably in our articles.


In this article:

  1. Red flags or verbal tests for Achilles tendon ruptures and tears

  2. Physical tests for Achilles tendon ruptures and tears

  3. Scans for a torn or ruptured Achilles tendon

  4. How we can help

“Rupture” usually refers to a complete tear, and “tear” can refer to either a complete or a partial tear, where a part of the tendon is torn and the rest is still intact.


Red flags or verbal tests for Achilles tendon ruptures and tears


When one of our physios assesses someone to figure out the cause of their Achilles pain, they listen very carefully when the patient tells them how the injury happened. They’re on the look-out for red flags that indicate that the patient does not have a mere Achilles tendonitis or tendinopathy, but that they actually have ruptured or partially torn their Achilles tendon.

Sudden Achilles pain

When you rupture or tear an Achilles tendon you usually feel a sudden sharp pain, whereas the pain caused by a tendonitis or tendinopathy most often sets in gradually. So, if your Achilles pain started all of a sudden while you were just walking around or doing sport, it could mean that you’ve ruptured or torn it.


Feels like a gunshot or kick to the Achilles tendon

Many of our patients who come to us with a ruptured or torn Achilles tendon describe the moment that it happened as feeling like they’ve been shot or kicked in the back of the leg. Some talk about feeling a “popping” sensation.


In addition to looking out for these red flags, our physio would then move on to some physical tests to further confirm or rule out the possibility of a torn or ruptured Achilles tendon.



Physical tests for Achilles tendon ruptures and tears


Please note that a partial Achilles tendon tear might slip under the radar with these physical tests. However, the red flags mentioned above will be sufficient to make the physio suspect a partially torn Achilles tendon.


Can’t walk on tiptoe

The physio would ask the patient to try to get up on their toes and then walk around for a while on tiptoe. Some people with a ruptured Achilles tendon might still get up on their toes, but they would not be able to walk around like that.


One of the tests for Achilles tears is to see if you can walk on your tip toes.

This is because, to remain on tiptoe, you have to contract your calf muscles, which then pull on the Achilles tendon, which in turn pulls the heel bone upwards and keeps it there. If your tendon is torn off, it can’t lift the heel bone off the floor. However, if it’s just partially torn, you may still be able to lift up on your toes and walk around.


Can’t push off when walking

The second test we ask the patient to do is to try and walk normally. If they are not able to propel themselves forward with the injured foot to take the next step, it would also raise suspicion about an Achilles rupture or tear. However, if you have a very painful tendon without a tear, you may also find it difficult to push off. So, this test should never be used on its own.


Angle between the ankle and foot

The patient lies on their stomach and bends their knees 90 degrees, so that their feet are up in the air. If the foot on the injured side hangs down much lower than the other foot, so that the angle between the foot and the ankle is smaller than on the uninjured side, this usually is a sign that the Achilles tendon is ruptured or torn, because it is not able to keep the foot in its normal position.


Calf squeeze test (Thompson’s test)

The patient lies on their stomach on a bed, with their feet dangling over the side. If you squeeze the calf muscle on the injured side, the foot will remain still if the tendon is fully ruptured. If the tendon is not ruptured (but there may still be a partial tear), the foot will move into plantar flexion (i.e. the toes will point away from the shin).


A gap in the tendon

This is not a good test for ruling out a rupture or tear, because you may still have one even if you can’t feel a gap in the tendon. Also, if this test is performed quite some time after the injury has happened, it is less likely that there will be a gap.


However, if you do feel a gap, it’s a strong indication that you have ruptured your tendon.


Testing for a gap in the tendon is not a very sensitive test for Achilles tendon ruptures.

Scans for a torn or ruptured Achilles tendon


If any of these red flags or tests makes you or your physio suspect that you’ve ruptured or partially torn your Achilles tendon, please see a doctor as soon as possible. If you delay, your injury will take much longer to recover, and it can have a negative effect on your healing process.


The doctor will probably send you for a scan, because this is the only sure way to confirm the diagnosis of a ruptured or partially torn Achilles tendon and if so, what the extent of the damage is. This can be either an ultrasound scan or an MRI scan.


We suggest ultrasound scans to our patients because they don’t cost as much as MRI scans, and they are more accessible. Often, the doctor can do an ultrasound scan right there on the day.


The scan will show the extent of the tear – whether it’s a rupture or a partial tear. If it’s a rupture, it will show how far the severed ends are apart. If it’s a partial tear, it will show how much of the tendon has been torn. This will be the guide to what happens next. You can read more about the treatment for complete Achilles ruptures and partial Achilles tears in these articles.


By the way, an X-ray is not useful for diagnosing Achilles ruptures and tears, because it only shows bones, not tendons.


How we can help


Need more 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.

Meet the TMA physios

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.

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About the Author

Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Master's Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate.




References:

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  2. Brukner & Khan et al. (2016) CLINICAL SPORTS MEDICINE: INJURIES, VOL. 1

  3. Guss, D., et al. (2015). "Acute Achilles tendon rupture: A critical analysis review." JBJS reviews 3(4).

  4. Manent, A., et al. (2019). "Acute Achilles Tendon Ruptures: Efficacy of Conservative and Surgical (Percutaneous, Open) Treatment—A Randomized, Controlled, Clinical Trial." The Journal of foot and ankle surgery 58(6): 1229-1234.

  5. Singh, D. (2017). "Acute Achilles tendon rupture." British Journal of Sports Medicine 51(15): 1158-1160.

  6. Wu, Yaohong, et al. "Is surgical intervention more effective than non-surgical treatment for acute Achilles tendon rupture? A systematic review of overlapping meta-analyses." International Journal of Surgery (2016).