You could have sworn someone had just kicked you from behind as you fell onto your knees, immediately losing all power in your leg. But when you turned around, there wasn’t anyone in sight. A sharp pain shoots through your leg, and you reach down to feel a strange divot at the back of your ankle. That’s when it hits you—something’s gone seriously wrong. You’re already thinking, “This is going to need surgery, no question.”

But here’s the thing—you might be wrong!

Believe it or not, Achilles ruptures are now often treated without surgery, using early immobilisation instead. Recent studies have shown that there’s only a minimal difference in the re-rupture rates between patients who go the surgical route and those who opt for conservative management. It’s a pretty big shift in how this injury is treated, and if your specialist agrees that your case is suitable for non-surgical treatment, it could mean avoiding the risks and recovery time associated with surgery altogether. Not bad for an injury that many people assume automatically requires going under the knife!

Understanding Achilles Rupture

Before we get into the nitty-gritty of treatment, it’s worth understanding a bit more about what an Achilles rupture actually is and how it happens.

Anatomy of the Achilles Tendon

The Achilles tendon is the largest and strongest tendon in the human body. It connects the calf muscles—specifically the gastrocnemius and soleus—to the heel bone (the calcaneus). This tendon plays a key role in everyday movements like walking, running, jumping, and even standing on your toes. Anytime you push off the ground with your foot, you’re engaging your Achilles tendon.

Because the Achilles tendon handles so much load and repetitive stress, it’s particularly vulnerable to injury. Ruptures occur when the tendon is suddenly overloaded, and the force is too great for the tissue to handle.

Cause

There are a few common scenarios where an Achilles rupture is likely to occur:

Sudden Forceful movements: This is often the culprit in ruptures, particularly during activities that involve a rapid change in direction or explosive pushing off. Think sports like basketball, football, tennis, or sprinting, where you need to go from stationary to full speed in a split second.

Chronic overuse: Over time, repetitive stress can weaken the Achilles tendon. This is especially common in athletes who don’t give their body enough time to recover between intense training sessions, or people who do a lot of walking or running on hard surfaces. Overuse creates micro-tears in the tendon, and over time, this wear and tear can lead to a full rupture.

Age and activity level: ruptures are more common in people aged 30 to 50, particularly those who engage in “weekend warrior” activities—high-intensity sports without proper conditioning or preparation. Tendons naturally become less elastic and more prone to injury as we age.

Symptoms of Achilles Rupture

Achilles ruptures are typically dramatic, and the symptoms aren’t hard to miss:

Sharp Pain: People often describe the pain of an Achilles rupture as feeling like they’ve been kicked or hit in the back of the leg. Some even hear a “pop” or “snap” when the tendon gives way.

Divot at the back of the ankle: If you feel a noticeable gap or divot where the Achilles tendon should be, that’s a classic sign of rupture.

Swelling and tenderness: The back of the leg and ankle will swell up fairly quickly after the injury, and the area will likely be very tender to the touch.

Difficulty walking: A ruptured Achilles tendon makes it extremely hard to push off your foot, making walking difficult. You may have a limp or find it impossible to bear weight on the injured leg.

Physiotherapy Interventions

If you’ve just experienced a rupture, you’re probably wondering what the next steps are. This is where a physiotherapist can make all the difference. Whether you end up going the surgical or non-surgical route, a tailored rehabilitation plan is crucial to ensure proper healing and to minimise the risk of re-injury.

Non-Surgical Management

More and more often, non-surgical management is being recommended for ruptures, especially for people who aren’t high-level athletes. The idea is that by immobilising the ankle and gradually increasing the range of motion and load through the tendon, the body can heal itself.

At XPHYSIO, we collaborate closely with a number of trusted orthopaedic surgeons. If you’ve been diagnosed with an Achilles rupture, we can arrange for you to be seen by a specialist who will help determine whether surgery is necessary or if non-surgical management is the better option. If non-surgical treatment is chosen, we would fit you with a VACOped CAM boot or a similar walker. These boots are designed to keep your foot at the right angle for optimal healing while allowing for adjustments over time as the tendon repairs itself.

Post-Surgery Rehabilitation

If surgery is necessary, rehabilitation becomes even more important. A physiotherapist will guide you through the post-surgical recovery process, ensuring that the tendon heals properly and regains its strength and flexibility.

Some key elements of post-surgery rehabilitation include:

Range of motion exercises: After surgery, the ankle is often stiff, and you’ll need to do gentle range-of-motion exercises to restore flexibility without putting too much stress on the healing tendon.

Strengthening Protocols: As you progress in your recovery, strengthening the muscles of the calf and the Achilles tendon is crucial. A physiotherapist will guide you through a gradual progression of exercises designed to rebuild strength without overloading the tendon too early.

Gait Training: After an Achilles rupture, walking normally can feel like a distant goal. A physiotherapist will work with you to retrain your gait and restore a natural stride, reducing the likelihood of compensatory movements that could lead to further injury.

Functional Exercises: These are exercises that mimic the movements you’ll be doing in your day-to-day life or sports activities. For example, if you’re a runner, your physiotherapist will incorporate exercises that prepare your Achilles tendon for the specific stresses of running.

Gradual Progression: The key to successful rehabilitation is a phased approach. Your physiotherapist will create a program that gradually increases the intensity and load on your Achilles tendon, ensuring that you don’t do too much too soon and risk a re-rupture.

Preventive Measures

Once you’ve fully recovered from an Achilles rupture, it’s important to take steps to prevent the injury from happening again. The Achilles tendon will be stronger, but it’s still vulnerable, particularly in the first year after injury. Here are some tips to keep your Achilles tendon healthy:

Proper Warm-up and Cool Down

This is something many of us skip, but it’s especially important after an Achilles rupture. Warming up properly increases blood flow to the muscles and tendons, making them more elastic and ready for exercise. Cooling down helps flush out lactic acid and promotes recovery. At XPHYSIO, we can provide you with a tailored warm-up and cool-down routine that suits your activity level.

Footwear and Equipment

Wearing the right shoes is another important preventive measure. Look for footwear that provides proper support for the arch of your foot and has good cushioning to reduce impact. If you’re an athlete, make sure your equipment (e.g. orthotics) is up to scratch and not worn out.

Cross-Training

Avoid doing the same type of exercise over and over, as this can lead to overuse injuries like an Achilles rupture. Instead, mix it up! Incorporate a variety of activities into your routine—swimming, cycling, yoga, strength training—to reduce stress on the Achilles tendon and work different muscle groups.

Conclusion

An Achilles rupture can feel like a devastating setback, especially if you’re active or involved in sports. But the good news is that with the right treatment, full recovery is achievable. Whether you go down the surgical or non-surgical route, working with a physiotherapist to create a personalised rehabilitation plan is critical to getting back on your feet—lit erally and figuratively.

At XPHYSIO, our team is here to help you through every step of your recovery. From initial diagnosis to rehabilitation and preventive care, we provide the support and expertise you need to make a successful comeback. With patience, dedication, and the right guidance, you’ll not only recover but come back stronger and more resilient than before.

So, if you’ve recently ruptured your Achilles or you’re experiencing symptoms that have you worried, don’t wait—reach out to a physiotherapist today and start your journey to recovery. You’ve got this!

References

Ochen Y, Beks RB, van Heijl M, Hietbrink F, Leenen LPH, van der Velde D, Heng M, van der Meijden O, Groenwold RHH, Houwert RM (2019). Operative treatment versus nonoperative treatment of Achilles tendon ruptures: Systematic review and meta-analysis. BMJ. 2019 364: 5120.