Achilles Tendinopathy vs. Achilles Tendon Rupture: Key Differences

Reviewed by the Physiotherapy Team at Waterloo Sports Medicine Centre 

Pain in the back of the ankle can make walking, running, or climbing stairs uncomfortable. Two common Achilles tendon injuries are Achilles tendinopathy and an Achilles tendon rupture. While both affect the same tendon, they are very different conditions that require different treatment approaches. Recognizing the signs early can help you receive the appropriate care and improve your recovery. 

What Is the Achilles Tendon? 

The Achilles tendon is the largest and strongest tendon in the body. It connects the calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus), allowing you to walk, run, jump, and push off your toes. Despite its strength, the tendon is vulnerable to injury from repetitive loading or sudden, forceful movements.

Achilles Tendinopathy 

Achilles tendinopathy is an overuse injury involving degeneration and impaired healing of the tendon rather than acute inflammation. It usually develops gradually after repeated loading exceeds the tendon's ability to recover. 

Common Symptoms 

• Gradual pain or stiffness at the back of the heel 

• Morning stiffness or pain when first taking steps after rest 

• Pain during or after running, jumping, climbing stairs, or prolonged walking 

• Tenderness when pressing on the tendon 

• Thickening of the tendon in some people 

• Symptoms that may improve as you warm up but worsen after prolonged activity

  
  

Common Causes and Risk Factors 

• Sudden increases in running or training volume 

• Repetitive jumping or running sports 

• Tight calf muscles or limited ankle flexibility 

• Poor load management or inadequate recovery between activities 

• Previous Achilles tendon injury 

• Middle-aged recreational athletes

  
  

Achilles Tendon Rupture 

An Achilles tendon rupture is a partial or complete tear of the tendon. It usually occurs suddenly during explosive movements such as sprinting, jumping, or changing direction. 

Common Symptoms 

• A sudden "pop" or snapping sensation in the back of the ankle 

• Immediate sharp pain (although some people experience surprisingly little pain) 

• Difficulty or inability to push off while walking 

• Weakness when standing on tiptoes 

• Swelling and bruising around the ankle 

• A noticeable gap in the tendon may sometimes be felt

  
  

Common Causes and Risk Factors 

• Sudden acceleration or jumping 

• Pivoting sports (basketball, volleyball, soccer) 

• Weekend athletes returning to sport after inactivity 

• Age between approximately 30 and 50 years 

• Previous tendinopathy 

  
  

How Is Each Condition Diagnosed? 

A healthcare provider or physiotherapist will perform a detailed assessment that includes your medical history, symptoms, and physical examination. 

For Achilles tendinopathy, diagnosis is primarily based on your symptoms and physical examination. Your healthcare provider or physiotherapist will assess the location of pain, tenderness along the tendon, swelling or thickening, and your ability to perform activities such as single-leg heel raises. Ultrasound or MRI may be recommended if the diagnosis is uncertain or another injury is suspected.

For a suspected Achilles tendon rupture, additional tests may include: 

• Thompson calf squeeze test 

• Assessment of plantarflexion strength 

• Ultrasound or MRI if the diagnosis is uncertain

  
  

How Can Physiotherapy Help? 

Achilles Tendinopathy 

Physiotherapy is considered the first-line treatment for Achilles tendinopathy. 

Treatment may include: 

• Progressive tendon-loading exercises 

• Calf strengthening 

• Flexibility and mobility exercises 

• Running and activity modification 

• Education on load management 

• Gradual return-to-sport planning 

A progressive loading program that gradually increases the tendon's capacity can reduce pain, improve strength, and help individuals safely return to daily activities and sport.

Achilles Tendon Rupture 

Whether treated surgically or non-surgically, physiotherapy is essential for recovery. 

Rehabilitation may include: 

• Guided protection of the healing tendon 

• Gradual weight-bearing progression 

• Range-of-motion exercises 

• Progressive strengthening 

• Balance and proprioception training 

• Walking retraining 

• Sport-specific rehabilitation 

  
  

Early functional rehabilitation has demonstrated excellent outcomes for many patients, compared to prolonged rest.

When To Seek Medical Attention for Achilles Pain? 

Seek assessment promptly if you experience: 

• A sudden pop in the back of your ankle 

• Inability to stand on your toes 

• Difficulty walking after an injury 

• Persistent Achilles pain lasting more than a few weeks 

• Pain that continues to worsen despite rest 

  
  

Looking for Achilles tendon injury treatment in Kitchener-Waterloo? The physiotherapists at Waterloo Sports Medicine Centre can help you return to the activities you love with an assessment and evidence-based treatment plans!