If you suspect that you’ve ruptured or torn your Achilles tendon, you must see a doctor as soon as possible. In this article, we explain what it feels like when you tear your Achilles tendon. We also run through the tests for Achilles tendon ruptures and tears that we use in our clinic and the red flags we look out for. And the we discuss what scans are used to finally confirm the diagnosis of a ruptured or torn Achilles tendon. Remember, if you need more help with an Achilles injury, you're welcome to consult one of our team via video call.
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:
“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.
Factors that can predispose you to tearing your Achilles tendon
Longstanding Achilles tendinopathy. When you have an ongoing tendinopathy, it weakens your tendon. That is why it is so important to get a robust rehab programme and make sure that you strengthen your Achilles tendon properly when you have a tendinopathy.
Fluoroquinolone antibiotics. This type of antibiotic has a really bad effect on the collagen in your body and can cause tendon injuries in as little as 1 dose and may also still affect it 6 months after taking the last dose. The most common one that is prescribed in the US is Ciprofloxacin or Cipro but they have several different brand names.
Systemic corticosteroids. If you’re taking corticosteroid tablets or inhalers, it may increase the risk.
Injections of corticosteroids. You also have an increased risk of rupturing your Achilles if you’ve had a corticosteroid injection into or around the Achilles tendon.
Older people are more at risk. This is usually linked to their activity levels. The less active you are and the less you load your Achilles tendon on a daily basis through walking or other activities, the weaker it will be. So if you then suddenly jump off a step or push a heavy object it may not be able to withstand that force. Regular exercise that load the Achilles tendon is the best way to mitigate against this.
Diabetes. Uncontrolled sugar levels can affect your tendon health.
I also discuss the typical symptoms and diagnosis of Achilles tendon tears in this video:
What it feels like when you tear your Achilles tendon
It usually happens during an activity where you load the calf and Achilles complex e.g. running, jumping, pushing a heavy object or in some cases just while walking or stepping down from something.
People often describe a sudden sharp pain or a sensation as if someone has kicked them on the heel or has hit them with a racket. You’ll often also hear a loud snap or pop, but not in all cases.
When you have a complete Achilles tendon tear, you may have surprisingly little pain. The research is showing that up to one third of patients will not report any pain in the Achilles tendon when they have a tear. This is because the tendon has fully snapped and therefore nothing is pulling on the injured tendon. People often describe just a mild ache in the calf or heel and a tiny bit of bruising or swelling.
You would expect someone with a torn Achilles tendon to struggle to walk, but this is also not the case for everyone. Most people will struggle to walk on their toes or do a single leg heel raise on the injured side, but if it is a partial tear or the other plantar flexor muscles are strong, you may still be able to go up on your toes without much problem.
It’s extremely important to have an Achilles tendon tear diagnosed and treated as soon as possible. If it is treated quickly, you can get back to normal walking as well as stair climbing within 12-16 weeks. However, if treatment is delayed, it can mean that your tendon heals in a lengthened position, and you may not be able to regain full strength.
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 about how the injury happened. They’re on the lookout 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.
Can’t push off when walking
If the patient is not able to walk normally, i.e. 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.
Alison also discusses these red flag symptoms in this video:
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 the physical tests mentioned below. However, the red flags mentioned above should be sufficient to make the physio suspect at least a partially torn Achilles tendon.
Test 1: 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.
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.
Test 2: Angle of the ankle/foot
With the patient lying on their stomach on a bed so that their feet are dangling freely over the edge, observe the angles of the feet. Compare the one foot with the other. If the Achilles tendon is torn, the foot on the injured side will hang in more dorsiflexion. This test was modified by Matless in that he would get patients to bend their knees to 90 degrees and then observe the angle of the foot. Again, the injured foot would drop into more dorsiflexion while the uninjured one will be in slight plantar flexion.
Test 3: The calf squeeze test (aka Thompson’s test)
With the patient lying on their stomach on a bed so that their feet are dangling freely over the edge, the clinician squeezes the calf muscles. If the Achilles tendon is torn, the foot will remain still while if the tendon is intact the foot will point down into plantar flexion (like in the picture) when you squeeze the calf.
Test 4: Feeling for a gap in the tendon
It’s not really that common to feel a gap in the tendon when it is torn. Also, the more time that passes between the moment you injure yourself and when someone performs this test, the less likely they are to feel a gap.
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 which might influence your treatment options. 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.
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
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.
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