Weekend warriors, athletes, and non-athletes can all experience an achilles tendon tear or rupture.  This classic sign that the tendon is completely torn is a feeling of getting hit with a baseball bat on the back of your leg.  From this point, it is very difficult to flex the foot in a downward position or plantar flex because the Achilles tendon is no longer attached and functional.  But surprisingly, most of my patients say that there is not a lot of pain with this injury after the initial jolt. 

This injury requires surgery.  No getting around it.  If it is treated within 1 week of the injury, a simple repair of the torn ends can be done.  We basically suture the ends of the tendon back together with very strong suture.  If it is over 1 week, the ends of the torn tendon start to die and get mushy and stringy.  Think horse tail.  This repair may require more imaginative thinking using your good tendon as a graft over the bad tendon area.  I have encountered some tendons with severe degeneration that required complete replacement with a cadaver tendon. 

Recovery is 6 weeks non-weightbearing in a cast, then 3-4 weeks in a walking boot with physical therapy for several weeks to regain strength and gait confidence.  Returning to non-weightbearing exercise can start when you are out of the boot.  But running takes much longer.