The Achilles tendon connects the calf muscles to the heel bone and is the strongest tendon in the body. It can rupture completely, tear partially or develop painful overuse degeneration (tendinopathy). A complete rupture typically occurs in people aged 30 to 50 during sports with sudden push-off, such as football, tennis, squash or basketball.
A fresh rupture can be treated successfully either with surgery or without it, provided modern early-movement rehabilitation is followed. A missed or neglected rupture is a different problem and generally needs reconstruction.
Symptoms
- A sudden snap or pop at the back of the ankle, often described as being kicked or struck from behind
- Sharp pain that may fade quickly
- Inability to push off, rise on tiptoe or climb stairs normally
- A gap felt in the tendon a few centimetres above the heel
- Swelling and bruising around the heel and ankle
- Tendinopathy: morning stiffness, a tender thickened tendon and pain during or after activity
Causes and risk factors
Rupture usually occurs in a tendon that has already degenerated silently, at a zone of relatively poor blood supply 2 to 6 centimetres above the heel. The typical patient is a man in his thirties or forties who plays sport intermittently. Risk is increased by fluoroquinolone antibiotics such as ciprofloxacin and levofloxacin, by steroid tablets or injections near the tendon, and by diabetes, kidney failure, gout, rheumatoid arthritis and a previous rupture on the other side. Tendinopathy results from training load exceeding the tendon's capacity to adapt.
How it is diagnosed
- Clinical examination: The calf squeeze (Thompson) test, a palpable gap and the resting position of the foot diagnose most complete ruptures without imaging.
- Ultrasound: Confirms the tear, measures the gap between the ends with the foot pointed downwards, and helps decide between surgical and non-surgical treatment.
- MRI: Used for neglected ruptures, partial tears and surgical planning.
- X-ray: Identifies a heel bone avulsion or a Haglund prominence when relevant.
Treatment options
- Functional non-surgical treatment: A boot with heel wedges, weight-bearing from the first or second week and wedges removed step by step over eight to ten weeks. Re-rupture rates approach those of surgery when the protocol is followed closely.
- Open or minimally invasive repair: The tendon ends are stitched together. Often preferred for athletes, large gaps and delayed presentation. It carries wound and nerve risks that non-surgical care avoids.
- Reconstruction of neglected ruptures: After about four to six weeks the ends retract. Repair then needs a tendon transfer (commonly flexor hallucis longus), a V-Y lengthening or a graft.
- Rehabilitation: Progressive calf strengthening for six to twelve months, whichever route is chosen. Some lasting calf weakness is common.
- Treatment of tendinopathy: Load management and a 12-week eccentric or heavy slow resistance programme first. Shockwave therapy comes second. Surgery is for the few who fail six months of rehabilitation. Evidence for PRP injections is weak.
When it is urgent
A sudden snap with loss of push-off strength needs assessment within a day or two, locally, because the choice of treatments narrows with delay. In a cast or boot, increasing calf pain and swelling, breathlessness or chest pain may indicate a blood clot and need emergency care.
Travelling to Türkiye for treatment
A fresh rupture should be treated where it happens, within days. If you are injured while in Türkiye, either treatment can begin there, but flying in a boot shortly after injury or surgery carries a raised clot risk, so ask about preventive anticoagulation. Planned travel makes sense for reconstruction of a neglected rupture or for surgery on long-standing tendinopathy: a night or two in hospital, about two weeks before flying, and then many months of physiotherapy at home with a written protocol.
Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.
Frequently Asked Questions
Is surgery better than a boot?
Surgery gives a slightly lower re-rupture rate but adds wound and nerve complications. With modern functional rehabilitation the long-term results are similar for most people.
When can I run again?
Usually around four to six months, with a return to cutting and jumping sports between six and twelve months.
I missed the diagnosis two months ago. Is it too late?
No, but a simple end-to-end repair is unlikely to be possible. Reconstruction with a tendon transfer gives good function.
Can steroid injections treat Achilles pain?
They are avoided in or around the Achilles tendon because they raise rupture risk.