Written by Zita Sham, Principal Physiotherapist at Phoenix Rehab, AHPC A1302159H.Clinically reviewed by Louise Yow, Principal Physiotherapist & Director, AHPC A1300363H.Last reviewed 12 October 2026.
An Achilles tendon rupture is a tear through the tendon that joins the calf muscles to the heel bone, usually on a push-off or a landing. It feels like a kick from behind. You may still walk, flat-footed, but you cannot rise onto your toes on that leg alone. That needs the emergency department now.
Key takeaways
- An Achilles tendon rupture is a tear through the tendon that joins the calf muscles to the heel bone. It happens on a push-off or a landing, and most people describe a kick from behind.
- You may still walk after a rupture. The sign is that you cannot rise onto your toes on that leg alone. A clinician confirms it with the Thompson squeeze test.
- A pop at the back of the ankle and no single-leg tiptoe needs the emergency department now. A calf that turns painful, swollen and warm in the weeks in a boot needs a doctor the same day.
- An operation and a boot without an operation are both used. Your surgeon decides, and the rehabilitation runs the same four stages either way.
- Walking is not the test of recovery. Single-leg heel raises, their height and their count against the other side, are.
Already in a boot, or after a repair? Go to the Achilles Rupture Recovery Program further down: the week-by-week, what is normal once the boot is off, and when you can drive or run.
What is an Achilles tendon rupture?
An Achilles tendon rupture is a serious tendon injury that occurs when the Achilles tendon, the strongest tendon in the body, is stretched beyond its capacity. The Achilles tendon connects the calf muscles to the heel bone, playing a critical role in walking, running, and jumping.
The two calf muscles, the gastrocnemius and the soleus underneath it, join into this one tendon and pull on the heel. Most ruptures happen a few centimeters above the heel bone, in the narrow part of the tendon you can pinch between finger and thumb. Doctors in Singapore often write it as a TA rupture, for tendo Achilles.
Achilles tendon ruptures are categorized as partial or complete.
- Partial rupture. A partial tear involves damage to some of the tendon fibers while others remain intact.
- Complete rupture. A completely torn Achilles tendon involves a total separation of the tendon fibers. Most acute ruptures are complete.
You cannot tell a partial tear from a complete one yourself. Treat it as a rupture until a doctor has examined the leg.
How does an Achilles tear happen?
The injury often results from sudden forced plantar flexion, such as during jumping, sprinting, or abrupt changes in direction. In plain terms, the calf contracts hard at the moment the tendon is being stretched. Three moments do it:
- The push-off. Driving off the ball of the foot with the knee straight: the first stride of a sprint, the lunge back to the rear corner in badminton, the jump for a rebound.
- The foot forced up. A missed step, a foot that drops off a curb or into a drain, and the ankle bends up under your whole weight.
- The landing. Coming down from a jump with the toes pointed and the heel driven to the floor.
Almost everyone describes the same thing: a bang at the back of the ankle, the certainty that someone kicked them or hit them with a racquet, and a turn around to see who did it. Nobody is there. In Singapore we see it in recreational players of badminton, basketball, football, tennis and pickleball, often in the first hard game after a break.
Who tears an Achilles?
- Recreational athletes: Those participating in sports involving abrupt movements or jumping, such as basketball or football, are at risk.
- Men aged 30 to 50: This demographic is particularly susceptible due to a combination of activity levels and age-related tendon degeneration.
- Individuals with pre-existing Achilles tendon disorders: Conditions like Achilles tendinopathy or chronic injuries weaken the tendon, increasing rupture risk.
- Patients on certain medications: Fluoroquinolone antibiotics are linked to a higher risk of Achilles rupture, most of all in older people who also take corticosteroid tablets.1 If you take either, that is a question for your doctor, not a reason to stop.
- People with a history of tendon injury: Those who have had a torn Achilles tendon or other tendon injuries are more vulnerable.
How do I know if I have ruptured my Achilles?
Try to rise onto your toes on that leg alone. After a complete rupture most people cannot, even though they can still walk flat-footed, because other muscles can point the foot. Many also feel a soft gap a few centimeters above the heel. A doctor or physiotherapist confirms it with the Thompson squeeze test.
The other common signs:
- Sudden Pain: Often described as sharp or severe pain in the lower leg or heel area, this pain typically arises during physical activity, such as jumping or sprinting.
- Popping Sound: Many individuals report hearing a “pop” or snapping sound at the moment of injury.
- Difficulty Walking: A ruptured Achilles tendon can make it challenging to push off the foot while walking.
- Swelling and Bruising: The foot and ankle area may swell or bruise shortly after the injury.
- Weakness in the Calf: Pushing off on that foot is weak or impossible, although many people can still point the foot down a little with other muscles.
- Tenderness: The area along the tendon may become tender to the touch.
Is an Achilles rupture painful?
The moment is sharp. Many people are surprised how fast it settles to an ache, and some walk on it for days for that reason. How much it hurts tells you little about whether the tendon is torn. The tiptoe on that leg alone tells you more.
The Thompson squeeze test, and scans
A clinician examines you lying face down with both feet over the end of the bed. The main check is the Thompson test, where the calf muscles are squeezed to check for plantar flexion of the foot. A lack of movement can indicate a tendon rupture. It is a test for a clinician, and not one to keep repeating at home on a fresh injury.
Ultrasound or MRI scans may be used to confirm the diagnosis, particularly if the rupture is partial or chronic. An X-ray does not show the tendon itself. Whether you need a scan is your doctor’s decision.
Achilles rupture, partial tear, tendinopathy, calf strain, plantaris or a clot?
Ask three things: was there one moment, where does it hurt, and can you rise onto your toes on that leg alone.
| Condition | How it started | What you notice | What it needs first |
|---|---|---|---|
| Achilles tendon rupture | A pop or a kick at the back of the ankle, on a push-off or a landing | You cannot rise onto your toes on that leg alone. Sometimes a gap you can feel above the heel. You may still walk flat-footed. A clinician checks it with the Thompson squeeze test | The emergency department now |
| Partial Achilles tear | The same kind of moment, sometimes less dramatic | Pain and weakness in the tendon. You may manage a weak tiptoe. You cannot tell it from a complete rupture yourself | The same as a rupture until a doctor has examined it |
| Achilles tendinopathy | No single moment. Builds over weeks of running or jumping | Stiff for the first steps in the morning and the first minutes of a run, in the tendon above the heel | Changes to the running load and calf loading |
| Calf strain (pulled calf muscle) | One moment: a sprint, a push-off, a hill, a curb step | A sudden pull or stab in the belly of the calf, higher up. You can still rise onto your toes, with pain | Ice, compression and elevation, short walks, then physiotherapy |
| Plantaris tear | A lunge or a push-off, less common | A sharp sting in the middle of the calf and a bruise that shows later. You can still rise onto your toes | A doctor, to rule out an Achilles rupture |
| Blood clot in the calf (deep vein thrombosis) | No strain moment. Often after a long flight, an operation, a cast or boot, or days in bed | A calf that is swollen, warm, red or tender, often the whole calf, aching on its own | A doctor the same day. Call 995 with chest pain or breathlessness |
Surgery or a boot?
The treatment approach for an Achilles tendon rupture varies based on the injury’s severity, the patient’s age, and their level of physical activity. Both surgical and nonsurgical methods can be effective, but the choice of treatment is tailored to the individual’s needs.
There are two routes. In an operation the surgeon stitches the torn ends together, through an open cut or a smaller, minimally invasive one. Without an operation the foot goes into a boot with heel wedges, toes pointed down so the ends lie together, and the wedges come out in steps as your surgeon sets.
A 2022 trial compared three groups: a boot without an operation, an open repair, and a minimally invasive repair. At 12 months, patients’ own scores of what the Achilles stopped them doing were similar in all three groups. Re-rupture was more common without an operation: 11 re-ruptures in the boot group, against one in each surgical group.2 An operation brings its own risks, including problems with the wound.
Which route suits your tendon, your age and your sport is your surgeon’s decision. The rehabilitation after either runs the same four stages, and it is long either way.
Questions to ask your surgeon
- What is the severity of my Achilles tendon injury?
- Is surgical intervention necessary, or can conservative treatment be effective in my case?
- Which wedges do I start with, and when does each one come out?
- When can I put weight through the boot, and when does it come off?
- How long will the recovery process take?
- What steps can I take during rehabilitation to minimize the risk of re-rupture?
- How soon can I return to regular physical activities or sports?
What to do in the first hours
- Stop. Do not walk it off, keep testing it, or stretch it.
- Go to the emergency department now. Take a taxi or get a lift rather than driving.
- Rest with the toes pointed down rather than pulled up toward you.
- Ice: Applying ice to the affected area reduces swelling and helps to relieve pain. Ice should be applied for 15-20 minutes at a time, several times a day.
- Pain relief and anti-inflammatory medication are a decision for your doctor or pharmacist.
The first weeks in the boot: what is usually normal?
Your surgeon sets the boot, the wedges and when you can put weight through it. Protocols for this injury vary more than most, so the plan in your discharge letter comes before anything here. These are usually normal in the first weeks:
- Swelling around the ankle and foot by evening, better after a night with the leg raised.
- Bruising that tracks down to the heel and the sole of the foot.
- A pull at the back of the heel for a day or two after each wedge comes out.
- A thick, lumpy feel along the tendon and the scar.
- A calf that shrinks inside the boot. That is expected, and it is the part the later stages train back.
Worth telling your surgeon soon: numbness or tingling along the outer edge of the foot after an operation, the boot rubbing a sore that is not healing, or swelling that is worse each week rather than better.
Keep moving the toes, the knee and the hip, keep the other leg, the hips and the trunk strong, and raise the leg when you sit. Leave alone: stretching the calf, taking a wedge out early, and walking without the boot before your surgeon clears it.
When to see a doctor first
- Call 995 if your calf is swollen and painful and you have chest pain, sudden breathlessness, or you cough up blood. In the weeks in a boot or after an operation, that can be a clot that has traveled to the lungs.
- Go to the emergency department now if you felt a pop or a kick at the back of the ankle and now cannot rise onto your toes on that leg alone, or you can feel a gap above the heel, even if you can still walk. The decision on a boot or an operation is made early. Also go now if, after treatment, you feel a new pop or give-way, or the push-off you had won back goes in a moment, which can mean the tendon has torn again. Also if the toes turn cold, pale or blue, or go numb, inside a cast or boot.
- See a doctor the same day if the calf becomes painful, swollen, warm, red or tender in the weeks in the boot or after the operation, which can mean a clot in the leg. Also the same day for a wound that is red, hot, opening or leaking, a fever, or a sore from the boot if you have diabetes.
- See a doctor soon if there is numbness along the outer edge of the foot after an operation, the boot has rubbed a sore that is not healing, or the heel raise and the walk have not changed over 3 to 4 weeks of rehabilitation.
What we measure
- Single-leg heel raises. How high the heel lifts on each side, in centimeters, and how many raises you manage to fatigue at a set pace. The heel-rise endurance test records both on each leg.3
- Calf girth. The widest part of each calf, in centimeters, at the same mark at each review.
- Ankle bend and resting angle. The knee-to-wall lunge in centimeters, and how the foot hangs at the end of the bed. A foot that hangs flatter than the other side relates to a tendon that has healed longer.4
- Hops. Single-leg hops in place and forward, counted and measured on each leg, before running speed comes back.
- The walk and the run. Whether you limp, how many minutes of walk-jog the tendon takes, and how it feels the next morning.
- Your own score. The Achilles Tendon Total Rupture Score, a short questionnaire on what the tendon stops you doing.
Tested, not dated. Jogging starts when you can do a set of single-leg heel raises on that side. Running sport comes back when heel raises and hops on that side measure up against the other leg. A 2016 review of return to play after Achilles rupture found that studies which defined how return was measured reported lower return rates than studies that did not, and called for a standard test.5
How long does an Achilles rupture take to recover?
Typical points are walking without the boot at 8 to 12 weeks, jogging at 4 to 6 months once the Stage 3 criteria are met, and running sport, jumping and badminton at 9 to 12 months or later. These are the ranges in the program below. Your surgeon’s protocol takes precedence, and the tests, not the date, decide each step.
The tendon knits in most people, with or without an operation. The calf takes longer. A calf that stays visibly smaller for a long time, often a year, is usually expected, and so is a heel that rises less high on that side than the other. That is why the program measures both.
Can you prevent an Achilles rupture?
Nobody can promise that. These lower the load the tendon meets without warning:
- Strengthening Exercises: Regularly perform exercises that target the calf muscles and foot and ankle stability to improve overall tendon resilience.
- Gradual Progression in Activity: Avoid sudden increases in physical activity, especially high-impact sports, to minimize the risk of acute Achilles tendon injuries.
- Coming back from a break: Return at a shorter, easier game than the one you left, and build up over weeks.
Achilles rupture treatment: who does what
- A doctor (the emergency department, your GP or a polyclinic doctor) examines the leg, does the Thompson test, decides whether you need an ultrasound or an MRI, decides about medication, including anything to prevent a clot, and refers you to an orthopedic surgeon.
- An orthopedic surgeon decides between an operation and a boot, sets the boot protocol (the wedges, when you can put weight through it, when it comes off), and clears you for sport.
- A physiotherapist runs the rehabilitation to your surgeon’s protocol: assesses, treats the stiffness and the swelling, measures the calf against the other leg, and moves you up a stage when you meet the criteria for it. If your surgeon referred you, they get a one-page report.
The four stages, applied to an Achilles rupture
In the Phoenix Recovery Protocol the work starts at Calm & Protect: the boot and the wedges as your surgeon sets them, the swelling, and the hip, knee and other leg kept strong. Move & Mobilize takes you out of the boot and walking without the limp, with the ankle bend coming back and no stretch into the tendon. Rebuild & Strengthen is the long one: calf strength from two legs to one, with heel raise height and count tested against the other side. Return & Perform tests the tasks themselves: the hop, the jog, the change of direction, the lunge on court. The measures set the pace.
Physiotherapy after surgery
Achilles Rupture Recovery Program
The tendon knits on a timetable. The calf does not come back on any timetable unless it is trained.
For Achilles tendon rupture managed with surgery or in a boot. The rehabilitation after either is the part that decides the result. A staged physiotherapy program run to your surgeon’s plan, at five Singapore clinics.
No referral needed to start. Bring your operation note, discharge summary or scan report.
Start here
Where are you right now?
An Achilles rupture is a different problem depending on the week you are reading this. Pick the one that matches.
How the program runs
4-Stage Structured Recovery
You move up a stage when you meet the criteria for it, not when a number of weeks has passed. That is Criteria Before Clearance, and it is why the last appointment is a graduation rather than a discharge.
The shape of it
What happens, week by week
The weeks below are the usual shape for a boot-based program after surgery or without it. Protocols vary more for this injury than most, especially on when weight-bearing starts. Your surgeon’s protocol takes precedence over anything on this page, every time.
- Weeks 0 to 2Stage 1 · Calm & ProtectBoot with heel wedges, crutches as your surgeon directs. Swelling down. The hip, knee and the other leg kept strong.
- Weeks 2 to 8Stage 1 · Calm & ProtectWeight through the boot as allowed. Wedges come out in steps. Gentle ankle movement inside the limits you are given, never a stretch into the tendon.
- Weeks 8 to 12Stage 2 · Move & MobilizeOut of the boot. A walk without a limp, range back through the ankle, and the first calf work.
- Months 3 to 9Stage 3 · Rebuild & StrengthenCalf strength, from two legs to one. Heel raise height and repetitions tested against the other side. Jogging usually starts in this stage, once the criteria are met.
- Month 6 onwardStage 4 · Return & PerformHopping, running, change of direction and your sport, tested rather than assumed. Many people take nine to twelve months to get back to explosive sport.
After the boot comes off
Is this normal?
Usually expected
- A calf that stays visibly smaller for a long time, often a year.
- A thickened tendon you can feel.
- Stiffness first thing in the morning that eases as you move.
- Swelling around the ankle by evening.
- A limp for the first weeks out of the boot.
- Calf fatigue long before the other side.
Contact your doctor
- Call 995 or go to the emergency department now: sudden shortness of breath, chest pain, or coughing up blood. After leg surgery these can mean a clot that has traveled to the lungs.
- Doctor the same day: a calf that becomes painful, swollen, warm or tender, which can mean a clot in the leg.
- Doctor the same day: fever, or a wound that is red, hot, opening or leaking.
- Emergency department now: a sudden pop or give-way after the boot comes off, with a new loss of push-off, which can mean the tendon has torn again.
- Review soon: no change in heel raise or walking over 3 to 4 weeks of therapy.
We would rather send you back to your surgeon early than be the reason you went late.
What does not reverse on its own
A tendon that heals long
After a rupture the tendon can heal longer than it was. In patients followed after Achilles rupture, tendon elongation was found early in recovery and was associated with a lasting deficit in how high they could rise onto their toes (Silbernagel and colleagues, American Journal of Sports Medicine, 2012). That is why the protected weeks matter, why the wedges come out in steps rather than all at once, and why nobody should be stretching a healing Achilles. Your surgeon sets those limits. We keep to them.
If it is not going to plan
Months out of the boot, and you still cannot rise onto your toes
You walk without a limp now. You are back at work. And when you try to stand on your toes on that side alone, the heel barely leaves the floor.
You take the stairs with the other leg first. You have not run for the bus since. The calf is a size smaller than the other one and has been for months.
Almost every Achilles that disappoints at a year is one where the calf work stopped when walking felt normal. Walking is not the test. A single heel raise is.
The Stalled Recovery Review is three appointments, one a week for three weeks, with the same physiotherapist. The first finds what is holding you back. The next two measure how it responds, because what a joint does under load cannot be read in one visit. $690, nett, no GST.
More on what the three appointments cover: the Stalled Recovery Review.
Logistics
When can I…
Your surgeon decides, based on healing and what your job demands. These are typical points, not permissions.
| Activity | Typical point | What has to be true first |
|---|---|---|
| Desk work | 1 to 2 weeks | Swelling controlled and you can get to work safely in the boot. |
| Driving | 2 to 12 weeks | Left leg in an automatic is often sooner. Right leg usually waits until the boot is off and you can brake hard. Your surgeon agrees, and check your insurer. |
| Walking without the boot | 8 to 12 weeks | Your surgeon clears it, and you walk without a limp on the flat. |
| Jogging | 4 to 6 months | Stage 3 criteria met, including a set of single heel raises on that side. |
| Running sport, jumping, badminton | 9 to 12 months or later | Stage 4 criteria met, including hop and heel raise tests against the other leg, and your surgeon’s clearance. |
| IPPT (sit-ups, push-ups, 2.4 km run) | The 2.4 km run around 9 to 12 months or later | Single-leg heel raises and hops on that side measured against the other leg. Your unit’s medical officer decides your medical status and when you take IPPT. |
| Medical certificate | Your doctor issues it | Physiotherapists do not issue MCs. We can write a report on your functional limits for your doctor or employer. |
The program
What it costs and what is in it
Achilles Rupture Recovery Program, Stages 1 to 4
Per 45-minute appointment, nett, no GST. The Achilles Rupture Recovery Program is 12 appointments, $2,760 in all. You pay for each appointment as you attend it. If you need more, your physiotherapist shows you which stage criteria are still open, and each extra appointment is $230.
- An Assessment & Treatment first, at $230: which stage you are in, what is limiting you, and a written plan you walk out holding
- Boot and wedge guidance through the protected weeks
- Staged range and calf strength work, progressed on criteria
- Heel raise height and repetitions measured against the other leg
- A home program, written down
- A one-page report to your surgeon at weeks 2, 6 and 12 if you were referred
- Your next stage review dated into the diary, with the same physiotherapist
Graduation, Not Discharge. The program ends when you meet the Stage 4 criteria for what you are going back to.
Who you will see
Managed by our physiotherapy team
Achilles ruptures sit with the physiotherapy team. You stay with the same physiotherapist through the program, and every appointment is one to one for the whole 45 minutes.
Zita Sham
Principal Physiotherapist at Orchard and Tampines. Achilles tendinopathy, rotator cuff pain and post-operative rotator cuff repair, and shoulder stiffness.
This program runs Stages 1 to 4 of the Phoenix Recovery Protocol. It sits under physiotherapy after surgery, alongside the other recovery programs.
Sources
Where the numbers on this page come from
- Silbernagel KG, Steele R, Manal K. Deficits in heel-rise height and Achilles tendon elongation occur in patients recovering from an Achilles tendon rupture. American Journal of Sports Medicine, 2012.
Timings on this page are typical ranges, not predictions for any individual recovery, and your surgeon’s protocol takes precedence. Physiotherapists assess, treat, exercise, educate and refer; doctors diagnose, inject, prescribe and order imaging. If we find something that needs medical review we refer you back to your doctor.
Related reading
Sources: 1. van der Linden PD, Sturkenboom MCJM, Herings RMC, Leufkens HGM, Rowlands S, Stricker BHCh. Increased risk of Achilles tendon rupture with quinolone antibacterial use, especially in elderly patients taking oral corticosteroids. Arch Intern Med. 2003;163(15):1801-1807. 2. Myhrvold SB, Brouwer EF, Andresen TKM, Rydevik K, Amundsen M, Grün W, Butt F, Valberg M, Ulstein S, Hoelsbrekken SE. Nonoperative or surgical treatment of acute Achilles’ tendon rupture. N Engl J Med. 2022;386(15):1409-1420. 3. Grävare Silbernagel K, Nilsson-Helander K, Thomeé R, Eriksson BI, Karlsson J. A new measurement of heel-rise endurance with the ability to detect functional deficits in patients with Achilles tendon rupture. Knee Surg Sports Traumatol Arthrosc. 2010;18(2):258-264. 4. Zellers JA, Carmont MR, Grävare Silbernagel K. Achilles tendon resting angle relates to tendon length and function. Foot Ankle Int. 2018;39(3):343-348. 5. Zellers JA, Carmont MR, Grävare Silbernagel K. Return to play post-Achilles tendon rupture: a systematic review and meta-analysis of rate and measures of return to play. Br J Sports Med. 2016;50(21):1325.
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