During the physical exam, your doctor will inspect your lower leg for tenderness and swelling. Your doctor might be able to feel a gap in your tendon if it has ruptured completely.
The doctor might ask you to kneel on a chair or lie on your stomach with your feet hanging over the end of the exam table. He or she might then squeeze your calf muscle to see if your foot will automatically flex. If it doesn’t, you probably have ruptured your Achilles tendon.
If there’s a question about the extent of your Achilles tendon injury — whether it’s completely or only partially ruptured — your doctor might order an ultrasound or MRI scan. These painless procedures create images of the tissues of your body.
Treatment for a ruptured Achilles tendon often depends on your age, activity level and the severity of your injury. In general, younger and more active people, particularly athletes, tend to choose surgery to repair a completely ruptured Achilles tendon, while older people are more likely to opt for nonsurgical treatment.
This approach typically involves:
Resting the tendon by using crutches
Applying ice to the area
Taking over-the-counter pain relievers
Keeping the ankle from moving for the first few weeks, usually with a walking boot with heel wedges or a cast, with the foot flexed down
Nonoperative treatment avoids the risks associated with surgery, such as infection.
However, a nonsurgical approach might increase your chances of re-rupture and recovery can take longer, although recent studies indicate favorable outcomes in people treated nonsurgically if they start rehabilitation with weight bearing early.
The procedure generally involves making an incision in the back of your lower leg and stitching the torn tendon together. Depending on the condition of the torn tissue, the repair might be reinforced with other tendons.
Complications can include infection and nerve damage. Minimally invasive procedures reduce infection rates over those of open procedures.
After either treatment, you’ll have physical therapy exercises to strengthen your leg muscles and Achilles tendon. Most people return to their former level of activity within four to six months. It’s important to continue strength and stability training after that because some problems can persist for up to a year.
A type of rehabilitation known as functional rehabilitation also focuses on coordination of body parts and how you move. The purpose is to return you to your highest level of performance, as an athlete or in your everyday life.
Rehabilitation after either surgical or nonsurgical management is also trending toward moving earlier and progressing faster. Studies are ongoing in this area also.