Mar 11, 2026

Preventing Achilles tendon sprains, strains, and tears

Roshawn Brown, MD, and George G.A. Pujalte, MD

Achilles tendon injuries, particularly tears, are a common problem for athletes, affecting their ability to play and their daily lives. The Achilles tendon is the largest and strongest tendon in the body. It connects the calf muscles to the heel bone and is crucial for activities such as running, jumping, and turning.

Athletes, especially those in sports with a lot of impact, are more likely to hurt their Achilles tendons because their bodies are under a lot of physical stress. Pain in the heel is often a sign that something is wrong with the Achilles tendon. 

Most Achilles tendon problems begin small and worsen over time if left unaddressed. The most frequent problem is “Achilles tendinopathy,” often called “Achilles tendinitis” (an accurate term only during the initial days of the injury). This injury stems from overuse of the tendon. The tendon becomes irritated, swollen, and painful due to excessive stress. The signs often include: 

1. Pain and stiffness in the back of the heel, especially when first getting out of bed in the morning; 
2. Pain along the tendon that is often worst at the beginning of an exercise and improves as the exercise continues; and 
3. Tenderness in the tendon.   

Along the spectrum of this condition, an Achilles tendon rupture is the worst outcome. This often involves complete tendon tearing, resulting in the inability to bear weight or point the foot downward. This usually occurs when an athlete attempts a quick and dynamic takeoff, or when there is a rapid change of direction. The difference between tendinopathy and rupture is apparent. The sooner an Achilles tendon rupture is treated, the better the outcome will be for an athlete.  

The signs of an Achilles tendon rupture are: 

1. A sudden, severe pain in the back of the ankle, with many people saying it feels like they were kicked in the heel; 
2. A loud “pop” or “snap” sound at the moment of injury; 
3. Pain that is also immediate, with difficulty putting weight through the foot; 
4. Swelling and bruising that may appear quickly around the ankle and lower leg; and 
5. Sometimes, a gap or dent that can be seen or felt over the tendon itself.

There are multiple ways to prevent injury to the Achilles tendon. Prevention involves managing factors related to the body (intrinsic factors) and activities being done (extrinsic factors). In terms of intrinsic factors, biomechanical malalignment is an example, as having very flat feet or very high arches can change the way athletes walk and run. This can put extra, uneven stress on the Achilles tendon.

Sometimes, special shoe inserts called orthotics can help correct the alignment and protect the tendon. Flexibility and strength are important, as weakness higher up the kinetic chain is often a culprit for Achilles tendon injury. Primarily, the gluteal muscles play a crucial role in stabilizing the hips, which subsequently relieves pressure from affecting the Achilles tendon. Therefore, having appropriate strength and flexibility in the muscles that surround the hip aids in preventing Achilles tendon injuries.  

In terms of extrinsic factors, errors in training contribute to Achilles tendon injury. Sudden and prolonged increases in training intensity are the most cited reasons leading to acute Achilles tendon injury. Tendons respond well to appropriate load management. The “10%” rule is often cited as a rule of thumb to guide how much an athlete should increase their training intensity weekly.  The shoes athletes wear also matter. Shoes that are worn out lose their cushioning and support, which increases the force exerted on the lower legs from activity. Wearing the wrong type of shoes for a sport can cause problems. Shoes should fit well and be replaced when they show signs of wear. Also, ensuring that footwear matches the terrain or surface being played on is important. Certain shoes are more suitable for turf fields, whereas others do better on grass fields. Warming up and cooling down are important. Athletes should always warm up before exercising to get blood flowing to the muscles and tendons, making them more flexible. A five- to ten-minute warm-up of light jogging and dynamic stretches is great.  

If an athlete develops Achilles pain, it is crucial to manage it correctly to prevent it from worsening. This often involves a period of rest and guided exercise developed by a physical therapist or athletic trainer. One core rehabilitation principle is reducing pain. This often involves resting from painful activities and using ice on the sore area for 15-20 minutes at a time. Improving flexibility by gently stretching the calf muscles is very important. Building strength is also important. The most beneficial exercises are usually eccentric movements, where the muscle is activated while lengthening, such as during heel-drop exercises. This involves standing on the edge of a step, raising the toes on both feet, and then very slowly lowering the heel down below the level of the step on the affected foot. Gradual return to activity is important. Once pain has subsided and strength has been restored, a gradual return to sport can be pursued.  

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For athletes who have sustained Achilles tendon ruptures, rehabilitation becomes much more intensive and takes longer. It may involve surgery to repair the tendon, followed by months of physical therapy to regain movement and strength. Achilles tendon ruptures frequently end athletic careers or prevent high-level athletes from returning to their prior level of performance. If it does happen despite prevention and recognition, management of an Achilles tendon rupture will require quick, insightful management and follow-up visits with a physician and a physical therapist. This is why recognizing the early signs of Achilles tendinopathy is essential, and prevention strategies are key.