Is It Achilles Tendinitis or a Rupture? Signs & Treatment Options

Achilles tendon injuries can sideline a wide range of active people, from seasoned marathon runners to first‑time pickleball players. 

That’s because it’s a critically important tendon — the strongest and largest in the body — connecting the calf to the heel bone and facilitating pushing off your toes to walk, run or jump.

Injuries to the Achilles tendon generally fall into two categories: tendinitis and ruptures. Tendinitis is inflammation of the tendon. A rupture is when the tendon is partially or fully torn.

“A ruptured Achilles tendon is often dramatic and unmistakable,” says Dr. Michael Cotton, an orthopedic surgeon at Houston Methodist.

While both conditions deserve attention, a rupture is urgent. Early evaluation can significantly influence treatment options and the return of strength over the long term. Understanding the signs of each injury can help you get the right care faster.

What are the signs of an Achilles injury?

A ruptured Achilles tendon can typically be traced back to the time and place of the injury. It’s a “step-off” injury, which occurs when the foot springs off the ground to propel forward.

With a rupture, many people describe:

• An audible pop or snap at the back of the ankle

• Swelling and pain in the back of the ankle

• Difficulty pushing off the foot or rising onto the toes

• The sensation of being kicked or punched in the back of the leg

“Patients mention this last sensation in particular all the time, says Dr. Cotton. “They turn around and expect someone to be there, and there’s nobody within 10 yards of them. That being said, they’re often able to walk afterwards.”

In contrast to a rupture, tendinitis usually builds gradually due to chronic overuse. The first signs typically appear after the irritation has progressed.

With Achilles tendinitis, people instead notice:

• Pain or stiffness with their first steps in the morning

• Swelling or tenderness at the back of the heel

• Symptoms that improve slightly as the tendon warms up

(Related: Why You Shouldn't Ignore Achilles Tendon Pain & What to Do About It)

Who’s at risk for Achilles injuries?

Anyone can be vulnerable to an Achilles tendon rupture or tendinitis. But certain people are at increased risk due to their biology or activities. Some risk factors include:

• Active adults, especially those who play basketball, soccer, tennis or pickleball

• People with tight calf muscles, which increases strain on the tendon

• Individuals with a history of Achilles tendinitis, which may weaken the tendon over time

• Weekend warriors who jump into high‑intensity activity without consistent training

“Many patients with ruptures have had intermittent tendinitis for years — tightness, soreness or recurring flare‑ups that temporarily improved with stretching,” says Dr. Cotton.

(Related: What Is an Overuse Injury & How Do You Prevent One?)

How is a ruptured Achilles tendon diagnosed?

Orthopedic specialists rely heavily on a physical exam, which can be surprisingly definitive. There's an area of the tendon that is hypovascular, which means it does not get great blood flow. This spot, where ruptures typically occur, is usually 2-6 centimeters (0.78-2.36 inches) above the heel.

“Oftentimes with a complete rupture, I'm able to actually feel the defect,” Dr. Cotton explains. “I can run my finger along the back of the ankle and can feel the little defect or a divot on the tendon.”

Other diagnostic exams include:

• Resting tension test: The patient lies on their belly with their knees bent at a 90-degree angle. In a resting position, a healthy Achilles creates a slight downward point in the toes, whereas a ruptured tendon leaves the foot more neutral or flat.

• Thompson test: The provider gently squeezes the calf. If the foot points downward, the tendon is intact. If the foot doesn’t move, it strongly suggests a rupture.

• Imaging: MRI is sometimes used if the physical exam is inconclusive.

Treatment options for Achilles ruptures

For an Achilles rupture, treatment depends on timing, activity level and patient preference. Dr. Cotton says the best outcomes happen when patients are evaluated within 48-72 hours of injury.

“A clear benefit to early care is that it may be possible for the ends of the tendon to be positioned closely enough to heal without surgery,” he says. “Outside of that time frame, closing the tendon without surgery is difficult. Even if the gap fills in with scar tissue over time, it will not be as strong as the original tendon.”

Non‑operative care typically includes:

• Immobilization in a boot for up to 12 weeks

• Gradual, structured rehabilitation

• Close monitoring to ensure proper healing

Surgery is often recommended for highly active individuals who want to minimize the loss of push‑off strength. It's also recommended in select cases where the tendon ends cannot heal on their own. This treatment path helps reduce the risk of re‑rupture and may offer a stronger long‑term repair.

Treatment options for Achilles tendinitis

To treat Achilles tendinitis, Dr. Cotton recommends a mix of approaches that may include:

• Stretching and strengthening exercises

• Physical therapy

• Topical anti‑inflammatory medication

• Heel lifts or padded sleeves to take tension off the tendon

• Short‑term immobilization in a boot for severe cases

Surgery for tendinitis may be an option if none of these options heal the problem after six months of treatment. In these cases, an orthopedic surgeon may remove damaged tissue from the tendon or lengthen the calf muscle.

(Related: 5 Signs You Might Benefit From Seeing a Physical Therapist)

Is there a risk of re-rupture?

Both surgical and non‑surgical approaches carry some risk of re‑injury, but:

• Non-operative treatment has a slightly higher re‑rupture rate

• Surgery is often preferred by highly active individuals who want to preserve push‑off strength and reduce the chance of another rupture

Regardless of treatment, returning to high‑impact sports always carries some risk — but most patients do get back to the activities they love.

When should you seek medical care for pain at the back of the ankle?

“If you feel a pop, call your doctor’s office and let them know so you can get in as soon as possible,” Dr. Cotton urges. “If you also hear a popping sound or have sharp pain in the back of your ankle, don’t wait. Early evaluation can expand your treatment options and improve your long‑term outcomes.”

Whether you’re gearing up for a rec sports league or recovering from marathon season, listening to your body is the first ingredient for staying active, healthy and injury‑free.