Ask the Expert: Dr. Andrew Elliott, Orthopedic Surgeon, Answers Your Questions About Achilles Tendon Ruptures

Sitting woman banding her ankle on white background

Q1. I’m a runner and have heel pain that won’t go away. How does a doctor determine if it’s my Achilles?

An examination can usually determine if it is your Achilles or different problem that is the cause of your pain.Sometimes an MRI might be necessary if the exam is inconclusive.

Q2. I have Achilles tendonitis, but I’m concerned that it could become more serious. Am I at a higher risk for an Achilles rupture?

Tendonitis is a normal tendon that is inflamed and should not put you at a higher risk for an Achilles rupture. However, tendonosis involves some degeneration of the tendon that can be painful. Tendonosis may put you at a higher risk for rupture.

Q3. I’ve heard about paratenonitis and insertional tendonitis of the Achilles, can you explain the difference?

Paratenonitis is inflammation of the paratenon, the surrounding “tube” that the tendon glides in. Insertional tendonitis is where there is some degeneration of the fibers of the tendon where they attach to the heel. It can be painful and you may form some thickness in the tissues there. An X-ray may show some calcification or a bone spur.

Q4. I’m an active runner. Are there ways to prevent myself from rupturing my Achilles tendon?

Stretching before and after activity may help prevent an Achilles rupture. Also, many of the running shoes these days have a slightly more elevated heel, which can take strain off the tendon. Varying your workout and cross training may help avoid overuse syndromes that can lead to tendon problems. In some patients, fluoroquinolone antibiotic medications may be associated with raising the risk of tendonosis and ruptures, so if you can avoid taking these drugs that may also help.

Q5. What are my treatment options for a ruptured Achilles tendon?

Repairing the Achilles with open surgery (3-4 inch long incision) or minimally invasive (1 inch incision) are two ways that may fix the tendon. Depending on the type of rupture, and the time from rupture to treatment, using a specially designed boot may also allow the tendon to repair by itself.

The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.


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  1. Tore my achillies tendon about 10 years ago, did not have insurance at the time, still had a very small thin piece left but fell last week and tore the last string of it as well, have a disc of an MRI I had back in 2009, would like to get an appointment to see what you can do to repair this at this time, I now have Medicare insurance so I would like to get it fixed because I am currently in a cast from the emergency room over here in New Jersey.

    1. Hi John — If you reach out to our Patient Referral Service at 888-720-1982 they will be able to assist you best. Good luck!

  2. I have bilateral osteoarthritis dissecans of ankles medium talar dome lesions 3 and 4 mm. I also have bilateral frequent ankle sprains. Also Achilles tendonitis, heel bursitis, plantar fasciitis. I’m wondering If Dr. Elliott could help me with prp or stem cell harpy. I also have hamstring tendinodis, psoas and pelvic floor / pudendal nerve/ muscle spasms, left hip labral tear. Left hip trochanter lesser impingement. I’m looking for some direction, where to begin first and the best path to healing. My sit bones hurt from the tight hamstrings. Another doctor suggests gastroc recession, but given the multitude of issues, I’m concerned….any advice would be welcome. I am desperate to find proper help. I am not physically active and my only explanation is a psoas and pisiformis injury years ago during overly aggressive physical therapy for knee tendonitis. Thank you.

    1. Hi Denise — Thanks for reaching out. In order to help you best, please try reaching out to our Patient Referral Service at 888-720-1982. They will be able to identify if there is an appropriate physician for you to consider, and then that physician can decide on the appropriate treatment. Best of luck!

  3. I have a question…. My husband had an accident at work where his leg was crushed just below the knee by a 500 lbs piece of equipment. I was irritated from the beginning on the manor of care hr was receiving. His tibia and his fibula were both crushed and split down the middle to about the middle of the leg. Approximately 5-6 inches down from the knee. The hospital surgeon installed a stabilizer bar but due to the extensive injury he called on a bone specialist. Unbelievably they set the repair surgery for 3 weeks later. It had already been a week since the break when they said this so they werent even repairing his leg for a whole month which was seriously absurd but whatever. After they finally did the repair the bone specialist tells us that (I am trying to remember the exact terms) the ACL & MCL? were torn and needed to be repaired but he only does bones so he’d need another surgery very soon to get them repaired and he’d put a referral in for him. Well apparently he forgot then he moved to Cincinnati a week later. Since then we have said something about to all of the docs that workman’s comp has him going to and all of them refer back to the surgeon’s notes “I don’t see anything here about it” that’s fantastic. So this has been swept under the rug. In the meantime, he has had to do physical therapy 4 times a week, 2 land & 2 water. My question is; is all of this physical therapy pointless and in vain if his tendons are torn. It’s been 6 months and he still has trouble balancing but his still in a great deal of pain & in excruciating pain on the days he does therapy. He wants to trust these doctors and I’m his wife so he never listens to me anymore but I am certain that all of this therapy is simply a complete waste of time without the 2nd surgery to repair his tendons. Am I correct and if so how do I get these doctors to pay attention? They are saying his inability to move the leg easily is due to scar tissue that needs to be broken up which can only happen if he’s stretching the leg constantly. Please let me know how if I’m right. Thank you,
    Carrie. Littleton , CO

  4. I ruptured my Achilles tendon back in April 2015. I am an extremely active 62 year old mountain climber (not rock climbing, high altitude climbing). Because of insurance delays (don’t ask) I was unable to get it operated on promptly. The current gap is about 4 cm. I have seen two surgeons and they have conflicting opinions about the solution. One is says that an FHL tendon transfer is required. The other says that the rupture is too high for either a tendon transfer or a V-Y advancement and that I should have a graft using a portion of my hamstring tendon. Neither of them seem aware of the more current, minimally invasive techniques available. HELP!

  5. I have calcification and a bone spur in my right heel. Is there anything that can be done besides surgery. They said the bone spur is sticking out on a 90 degree angle it hurts all the time, but the pain in the leg is gone.

    1. Hi Lynne, thank you for reaching out. Dr. Mark Drakos, Orthopedic Surgeon, says: “Heel spurs are common and do not always necessarily cause pain. Often heel spurs are related to muscle and tendon tightness. As such, a daily calf stretching program may be helpful.” Before undergoing a new program, you should seek consultation with a physician so they can determine the best course of treatment. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.