®Thigh tighten and heel lift
Sit with your legs straight and place a rolled-up towel under your knee. Tighten your thigh to press the back of your knee into the towel and lift your heel. Hold for 3 seconds.
10 repetitions, with the boot onAges 30–50Most common age range
9–10 weeksApproximate time spent in a cast and boot with non-surgical treatment
6.2%Re-rupture after non-surgical treatment in one study; 0.6% after surgery
4–12 monthsTime to return to sport, depending on the sport
Symptoms
- Sudden pain in the heel or calf; it may then ease or go away.
- A “snap” at the moment of injury and a feeling of being struck in the back of the leg.
- Swelling and bruising in the calf.
- Walking flat-footed; being unable to stand on tiptoe or climb stairs.
What causes it?
- A forceful push-off or sudden lunge in sports such as football, tennis, badminton or squash.
- Falls and slips that force the foot upwards.
- Conditions that weaken the tendon: long-standing Achilles tendinopathy, some rheumatic conditions, long-term steroids and some antibiotics.
How does treatment progress?
1
Go to A&E straight away
Diagnosis is usually made by examination: a gap can be felt in the tendon, and the foot does not move when the calf is squeezed. An ultrasound scan may be done if needed. The leg is put in a cast with the foot pointing down.
2
Boot and heel wedges
After the cast, you are given a boot with wedges that raise the heel, or one with an adjustable angle; the wedges are reduced every few weeks. The boot stays on at all times, including in bed.
3
Preventing blood clots
Being less mobile raises the risk of a blood clot in the leg. If you are at risk, you may be given blood-thinning injections for a few weeks.
4
Step-by-step rehabilitation
Physiotherapy starts towards the end of the boot phase. Ankle movements, heel raises and cycling are added step by step; running and jumping come last.
Exercises for the boot phase
Five exercises to keep the leg strong
These exercises are done with the boot on, to keep your knee and hip muscles strong. Do not take the boot off or move your ankle on your own. For the standing exercises, your team must have allowed you to put weight on your foot. Start ankle exercises only when your physiotherapist says so and under their supervision.
Straight leg raise
Lie on your back or sit with your legs straight. Keeping your knee straight, lift your leg, hold for 3 seconds and lower slowly.
10 repetitions, with the boot onSeated knee extension
Sit on a chair. Tighten your thigh to straighten your knee and hold for 3 seconds, then lower slowly.
10 repetitions, with the boot onStanding hip extension
Stand tall holding on to a worktop or the back of a chair. Slide your leg backwards and squeeze your buttock. Hold for 3 seconds, then return to the start.
10 repetitions, with the boot onStanding hip abduction
Stand tall holding on to a worktop. Slide your leg out to the side, hold for 3 seconds and return to the start.
10 repetitions, with the boot onFrequently asked questions
Surgery or a boot?
In a Norwegian study of 554 people aged 18–60, non-surgical treatment, open surgery and minimally invasive surgery gave similar results after one year. The tendon re-ruptured in 6.2% of the non-surgical group and 0.6% of the surgical groups; nerve injury occurred in 0.6% of the non-surgical group, 2.8% after open surgery and 5.2% after minimally invasive surgery. Surgery is considered more often for late presentation (more than 2–3 weeks), re-rupture, the tendon pulling away from the bone and elite athletes. The decision is made with your doctor.
My pain has gone; should I still see a doctor?
Yes. After a rupture, the pain can ease or even go away; this does not mean the tendon is intact. If diagnosis and treatment are delayed, the option of non-surgical treatment may narrow.
How can I prevent a re-rupture?
The first 6 weeks after the boot comes off is when the risk of re-rupture is highest; avoid sudden stretching of the tendon during this time. Wear shoes with a heel of at least 2.5 cm and the same height on both sides. Take care on uneven ground; on stairs and kerbs, place your whole foot, including the heel, on the step.
When can I drive?
Do not drive in a cast or boot. You can start once the boot phase is over and you can do an emergency stop safely and without pain. If the rupture is on your left side and you drive an automatic, it may be possible sooner; ask your doctor.
When can I return to work and sport?
People usually return to desk work after 8–12 weeks and to physical work after 3–6 months. According to one NHS guide, cycling and swimming can resume after 12–14 weeks, golf after 6–9 months, racket sports after 9–12 months and contact sports after about 12 months. Symptoms settle in 4–6 months, and improvement can continue for 12–18 months.
For Achilles pain that builds up gradually without a rupture, see the Achilles tendinopathy guide; for pain after a sprain, see the ankle sprain guide.
When should you go to A&E or see a doctor?
- If you have signs of a rupture: go to A&E straight away
- If you have sudden, cramp-like pain in your calf, thigh or groin (it may be a sign of a blood clot)
- If you have chest pain or shortness of breath: call 112 straight away
- If swelling suddenly increases, or you have numbness or pins and needles
- If you had surgery and your wound is red, leaking or opening
Sources
- Royal Berkshire NHS Foundation Trust. Achilles tendon rupture: conservative management. October 2025.
- Sherwood Forest Hospitals NHS Foundation Trust. Achilles tendon rupture. PIL202606-03-ATR, June 2026.
- NHS Fife. Achilles tendon rupture. February 2024.
- Myhrvold SB, Brouwer EF, Andresen TKM, et al. Nonoperative or surgical treatment of acute Achilles’ tendon rupture. N Engl J Med. 2022;386(15):1409–1420.