What is an Achilles Tendon Injury? Symptoms, Diagnosis, Treatment & Recovery

The Achilles tendon connects the calf muscles to the heel bone and plays an essential role in walking, running, jumping, and pushing off the foot. Because it is exposed to significant force during athletic movement, it can become painful, partially torn, or completely ruptured.

In this edition of Dr. Rick Informs, Dr. Rick Lehman explains what an Achilles tendon injury is, who is most likely at risk, the factors that increase risk of injury, how Achilles tendon injuries are treated, and most importantly, how to prevent them in the first place.

What is an Achilles tendon injury?

An Achilles tendon injury is among the most common and most disruptive injuries for active adults. It often strikes suddenly, with a sharp pain in the back of the heel that many people describe as feeling like someone kicked them in the leg. It can range from persistent tendon pain to a partial or complete tear.

Achilles Tendinopathy

Achilles tendinopathy develops when the tendon becomes painful, and its structure begins to change. People may notice soreness, stiffness, thickening, or a knot along the tendon.

The condition is more commonly known as Achilles tendonitis, an inflammation of the Achilles. However, not all persistent Achilles pain is caused by active inflammation, so Achilles tendinopathy is often the more accurate general term.

Partial Achilles Tear

A partial tear occurs when some tendon fibers are disrupted while others remain intact.

The symptoms and severity can vary. An ultrasound or MRI may be used when a physician needs to determine how much of the tendon is affected or clarify the diagnosis.

Complete Achilles Tendon Rupture

A complete rupture occurs when the tendon tears all the way through.

Many patients describe a sudden, sharp pain in the back of the ankle or heel. Some people also hear or feel a pop. A complete rupture can make it difficult to push off the injured foot, walk normally, or rise onto the toes.

Who Is Most Likely to Get an Achilles Injury?

Achilles ruptures frequently occur in active adults, particularly men between approximately 35 and 60 years old who participate in sports requiring explosive movement.

Activities commonly associated with Achilles injuries include:

• Pickleball
• Basketball
• Softball
• Soccer
• Tennis and other racquet sports
• Running and sprinting
• Sports involving jumping, cutting, or sudden changes of direction

An injury can occur when a person accelerates rapidly, lands from a jump, changes direction, or suddenly loads a tendon that is not prepared for the force.

Risk Factors for Achilles Tendon Problems

Several factors may increase the likelihood of Achilles pain or rupture:

• Tight calf muscles
• A tight Achilles tendon
• Previous Achilles tendonitis or recurring pain
• Obesity
• Smoking
• Diabetes
• Sudden increases in the amount or intensity of sports training
• Lots of uphill running
• Over-pronation, where the feet roll inward and flatten out more than normal when you walk or run
• Wearing high heels at work and then switching to lower-heeled shoes for exercise
• Poor conditioning before returning to sport
• Recent use of certain antibiotics, such as ciprofloxacin (Cipro) or levofloxacin (Levaquin)
• Prior cortisone injections in or around the Achilles tendon area

A Note on Antibiotics and Cortisone

Certain medications matter more than people realize. Antibiotics in the fluoroquinolone class, such as ciprofloxacin (Cipro) and levofloxacin (Levaquin), are known to create toxicity to the tenocytes (the cells that make up tendon tissue) and decrease matrix synthesis. In short, these antibiotics can cause tendinitis and may contribute to a rupture.

Prior cortisone injections carry similar concern. Dr. Rick’s advice on this point is direct: do not get a cortisone injection in your Achilles.

“Make sure you discuss all of your medications with your Doctor. Medicines may be problematic for your tendon health. Also discuss any supplements you are taking.”

Dr. Rick Lehman

What Are the Symptoms of an Achilles Tendon Injury?

Symptoms depend on whether the problem is tendinopathy, a partial tear, or a complete rupture.

Warning signs may include:

• Pain at the back of the ankle or heel
• Morning stiffness
• Swelling or thickening of the tendon
• A noticeable knot along the tendon
• Pain during running, jumping, or pushing off
• Sudden sharp pain during activity
• A popping sensation
• The feeling of being kicked in the back of the leg (but no one is there!)
• Difficulty walking normally
• Pain or weakness when rising up on your toes
• Difficulty lifting your heel off the ground or pointing your toes

If you experience sudden pain, a pop, or an inability to push off the foot, consult your doctor as soon as possible.

How Is an Achilles Injury Diagnosed?

Diagnosis begins with a medical history and physical examination.

Your doctor may ask you:

• How the injury occurred
• Where the pain is located
• Whether there was a pop
• Whether you have experienced previous
• Achilles symptoms
• What medications you have recently used and currently use
• Whether you have had any recent and ongoing treatment

During the examination, they may evaluate:

• Tenderness and swelling
• A gap or defect in the tendon
• Ankle movement
• Push-off strength
• The ability to rise onto the toes
• The response of the foot when the calf is squeezed

Injuries are identified through imaging, either by an MRI or an ultrasound.

How Is an Achilles Injury Treated?

Treatment depends on whether the injury is a partial tear or a complete rupture. This determines whether you need non-surgical or surgical treatment, as well as the intensity of your rehabilitation.

Treating Partial Tears

Partial tears are generally treated conservatively, without surgery. Common conservative treatments include:

Treatment may include:

• PRP (platelet-rich plasma) injections
• Exosome injections
• Bracing

Exosome injections are not currently FDA-approved and are considered investigational.

Treating Complete Tears

Complete tears can be treated either surgically or non-surgically. In recent years, Dr. Rick has increasingly favored non-surgical management, especially for older individuals and those who are less active.

Non-surgical

For non-surgical treatment, the approach involves placing you in a plantar flexion protection brace. This prevents the foot from bending all the way down, keeps you in a functional brace, and allows rehabilitation to begin.

Surgical

When surgery is appropriate, minimally invasive approaches are preferred to aid recovery. This generally includes:

• Fewer and smaller incisions
• Early rehabilitation
• Biologics

Rehabilitation After an Achilles Injury

Rehabilitation should protect the healing tendon while progressively restoring movement, calf strength, balance, and sport-specific function.

A tailored rehabilitation program may include:

• Early protection in a boot or brace
• Gradual progression of weight-bearing
• Controlled restoration of ankle movement
• Progressive calf strengthening
• Balance and neuromuscular training
• Running progression
• Cutting, jumping, and sport-specific drills
• Functional testing before unrestricted participation

Dr. Rick may also incorporate blood flow restriction training in appropriate patients. This technique allows certain strengthening exercises to be performed with lighter loads under professional supervision.

The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible, guided by your treating sports medicine specialist. If you return too soon you may worsen your injury, while moving too slowly may contribute to stiffness, weakness, and loss of function.

What You Can Do at Home

There are steps you can take at home to support your recovery:

• Apply ice packs to the Achilles tendon for 20 to 30 minutes every 3 to 4 hours for the first 2 to 3 days, or until the pain subsides.
• Raise your lower leg on a pillow when lying down.
• Take anti-inflammatory medication as prescribed and advised by your doctor.
• Perform gentle stretching to maintain flexibility without overstressing the tendon.
• Use gentle compression, such as a compression stocking, to help manage swelling.

When Can You Return to Your Sport or Activity?

Return to your activity is determined by how soon your Achilles tendon area recovers, not by how many days or weeks it has been since your injury occurred. In general, the longer you have symptoms before you start treatment, the longer it will take to get better.

Recovery from an Achilles injury follows a general timeline*:

• Two to six weeks in a brace
• Two to six months of strengthening
• Running at about four months
• Cutting movements at about six months
• Full participation at about nine months

*These are general estimates rather than guaranteed deadlines.

How Can I Prevent an Achilles Injury?

Prevention is the most important part of protecting your Achilles. Dr. Rick recommends:

• Lots of stretching
• Regular and progressive calf strengthening
• Getting an ultrasound or MRI if you have any pain
• Wearing supportive, stable footwear

Choosing the Right Footwear for Achilles Tendon Problems

Shoe wear is very important for athletes with Achilles tendon concerns. Dr. Rick recommends:

• High-top or mid-high-top shoes
• A high level of stability, with a strong medial counter
• An ankle compression sleeve, which can provide additional support

If you have any doubts, see your doctor, get the right assessment, and get on a rehabilitation program. To see an expert, contact Dr. Lehman.

What’s Coming Next in Achilles Care

The future of Achilles treatment is promising. Dr. Rick expects future advances to include:

• Preventive treatment using AI
• Wearable sensors
• Ultrasound to assess the tendon structure
• Better sutures

“A complete rupture of the Achilles tendon is a full-on disaster. It is much easier to treat a partial tear or tendinitis, so be vigilant, and if you are experiencing tightness, pain or swelling, get evaluated ASAP”

Dr. Rick Lehman

Prevention Is the Best Medicine

Achilles injuries are common in active adults, but they are also highly preventable. If you have a history of Achilles pain, feel a knot in the back of your leg, or fall into a higher-risk category, take action early: see your doctor, get the right assessment, and follow a proper rehabilitation program.

As Dr. Rick says, it is much easier to prevent an Achilles injury than to treat a complete rupture.

Stay healthy, stay active, and take Achilles pain seriously.