The Achilles tendon connects your calf muscles to your heel bone. Together, they help you push your heel off the ground and go up on your toes. You use these muscles and your Achilles tendon when you walk, run, and jump.

If your Achilles tendon stretches too far, it can tear or rupture. If this happens, you may:

• Hear a snapping, cracking, or popping sound and feel a sharp pain in the back of your leg or ankle
• Have trouble moving your foot to walk or go up stairs
• Have difficulty standing on your toes
• Have bruising or swelling in your leg or foot
• Feel like someone hit you at the back of your ankle with a bat

Heel cord tear; Calcaneal tendon rupture

Most likely your injury occurred when you:

• Suddenly pushed your foot off the ground, to go from walking to running, or to running uphill
• Tripped and fell, or had another accident
• Played a sport like tennis or basketball, with a lot of stopping, sharp turns, and jumping

Most injuries can be diagnosed during a physical exam. You may need an MRI scan or ultrasound to see the location of your Achilles tendon tear. MRI and ultrasound are types of imaging tests.

• A partial tear means at least some of the tendon is still OK.
• A full tear means your tendon is torn completely and the 2 sides are not attached to each other.

If you have a complete tear, you may need surgery to repair your tendon. Your health care provider will discuss the pros and cons of surgery with you. Before surgery, you will wear a special boot that keeps you from moving your lower leg and foot.

For a partial tear:

• You may need surgery.
• Instead of surgery, you may need to wear a splint or boot for about 6 weeks. During this time, your tendon grows back together.

If you have a leg brace, splint, or boot, it will keep you from moving your foot. This will prevent further injury. You can walk once your provider says it is OK.

To relieve swelling:

• Put an ice pack on the area right after you injure it.
• Use pillows to raise your leg above the level of your heart when you sleep.
• Keep your foot elevated when you are sitting.
• Use a boot for walking or crutches to take weight off your ankle.

You can take ibuprofen (such as Advil or Motrin), naproxen (such as Aleve or Naprosyn), or acetaminophen (such as Tylenol) for pain.

Remember to:

• Talk with your provider if you have heart disease, liver disease, high blood pressure, kidney disease, or have had stomach ulcers or bleeding.
• Quit smoking (smoking can affect healing after surgery).
• Not give aspirin to children under 19.
• Not take more pain killer than the dosage recommended on the bottle or by your provider.

At some point as you recover, your provider will ask you to begin moving your heel. This may be as soon as 2 to 3 weeks or as long 6 weeks after your injury.

With the help of physical therapy, most people can return to normal activity in 4 to 6 months. In physical therapy, you will learn exercises to make your calf muscles stronger and your Achilles tendon more flexible.

When you stretch your calf muscles, do so slowly. Also, do not bounce or use too much force when you use your leg.

After you heal, you are at greater risk for injuring your Achilles tendon again. You will need to:

• Stay in good shape and stretch before any exercise
• Avoid high-heeled shoes
• Ask your provider if it is OK for you to play tennis, racquetball, basketball, and other sports where you stop and start
• Do a proper amount of warm up and stretching ahead of time

Contact your provider if you have any of these symptoms:

• Swelling or pain in your leg, ankle, or foot becomes worse
• Purple color to leg or foot
• Fever
• Swelling in your calf and foot
• Shortness of breath or difficulty breathing

Also contact your provider if you have questions or concerns that cannot wait until your next visit.

Rose NGW, Green TJ. Ankle and foot. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 49.

Sokolove PE, Barnes DK. Extensor and flexor tendon injuries in the hand, wrist, and foot. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 48.