If you're reading this, you've likely just experienced one of the most distinctive injuries in medicine - a ruptured Achilles tendon. That unmistakable "pop" or "snap" followed by difficulty walking has brought you here. This guide will walk you through everything you need to know about your first week of recovery.
Quick Action Plan (First 24 Hours)
If you only read one section, read this.
Do
- •Protect the tendon 24/7 - keep your foot in the pointed-down position your clinician set (cast/splint/boot)
- •Assume you're non-weight-bearing unless told otherwise - use crutches and move slowly
- •Elevate your ankle above heart level as much as possible
- •Know the clot red flags (DVT/PE) and seek urgent care if they appear
- •Arrange follow-up (fracture clinic/orthopaedics) if it hasn't been booked
Don't
- •Don't stretch your Achilles or calf
- •Don't walk barefoot or "test it" without protection
- •Don't remove the cast/splint/boot unless your team explicitly told you it's safe
- •Don't ignore new calf pain, chest pain, breathlessness, or one-leg swelling
Safety Note
Understanding Your Injury
What Just Happened to Your Achilles Tendon
The Achilles tendon is the largest and strongest tendon in your body, connecting your calf muscle to your heel bone. When it ruptures, the tendon fibres tear - think of it like a rope that has frayed and snapped. This disconnects your powerful calf muscle from your heel, which is why you suddenly can't push off the ground properly or stand on your tiptoes.
The "Snap" - Why It Happened and What It Means
Most people describe the moment of rupture as:
- A sudden "pop" or "snap" sound
- Feeling like someone kicked or hit the back of your ankle
- Immediate difficulty walking
- A sensation that something has "given way"
The initial pain from the rupture is often intense but typically subsides quickly - sometimes within minutes. This can be misleading, as the injury is serious even when the pain diminishes. The fact that you could walk (albeit with difficulty) to A&E doesn't mean the injury isn't severe.
Important
If You Hear "Gap Size" (e.g. "4cm gap")
Clinicians sometimes measure the distance between the torn tendon ends on ultrasound. Think of it like a snapped rope — the "gap" is how far apart the ends are in that position. What often matters most is whether the ends come together when the foot is held pointed down in a cast/boot/splint. Don't panic if you hear a number — it's one piece of the puzzle your specialist will interpret in context.
Is It Definitely a Rupture?
Common signs that suggest an Achilles rupture:
- The "pop" or "snap" sensation during activity
- Sudden pain at the back of the ankle
- Inability to stand on tiptoe on the affected leg
- A gap or indent you can feel in the tendon
- Significant swelling and bruising (develops over hours)
- Difficulty pushing off when walking
If you haven't yet been assessed, get to A&E or an urgent care centre as soon as possible. The sooner treatment begins, the better your outcome will be.
Emergency Room & Initial Care
What to Expect at A&E/ER
When you arrive at A&E, here's the typical process:
- Triage: You'll be assessed and categorised by urgency. An Achilles rupture isn't life-threatening, so you may wait, but you will be seen.
- Physical Examination: A doctor will perform the Thompson test (also called the Simmonds test) - they'll squeeze your calf while you lie face-down. In a healthy tendon, this makes your foot point downward. If your Achilles is ruptured, your foot won't move.
- Immobilisation: Your foot will be placed in a "tip-toe" position (plantarflexion) to bring the torn tendon ends closer together. This is typically done with a plaster backslab (half-cast), a trauma splint, or in some cases, a walking boot from the start.
- Crutches: You'll be given crutches to keep weight off your injured leg.
- Referral: You'll be referred to an orthopaedic specialist or fracture clinic for further assessment, typically within 1-3 weeks.
Pain Management in the First 24-48 Hours
The good news: Achilles rupture pain typically peaks at the moment of injury and then decreases significantly. Most people find the discomfort manageable within the first day or two.
- Paracetamol: Safe and effective for most people
- Ibuprofen or Naproxen: Anti-inflammatories that also help with swelling (check with your doctor if you have kidney issues, stomach problems, or are on blood thinners)
- Ice: Apply for 15-20 minutes every 2-3 hours during the first 48 hours (always with a cloth barrier to protect your skin)
- Elevation: Keeping your leg raised reduces swelling and discomfort
The Trauma Splint or Plaster Cast
Your foot needs to be held in a pointed position (equinus) to allow the torn tendon ends to heal back together. This is non-negotiable in the first weeks.
- A half-cast that wraps around the back of your leg
- Cannot be removed by you
- Must be kept completely dry
- Will be replaced by a walking boot at your specialist appointment
- A removable splint that holds your foot in the correct position
- Lighter than plaster
- May allow for earlier boot fitting
- Still must be worn 24/7 unless instructed otherwise
- Some hospitals fit a boot with wedges straight away
- Must be worn 24/7 including during sleep
- The wedges hold your foot at the correct angle
Getting Your Crutches and Learning to Use Them
Crutches are essential in Week 1. Your injured leg should bear minimal or no weight initially.
- Adjust them so the top sits about 2 inches below your armpit
- Your elbows should be slightly bent when holding the grips
- Take your weight through your hands, not your armpits
- Move crutches and injured leg together, then step through with your good leg
- Go slowly - falling now would be a disaster
Top Tip
Lean your crutches upside-down (with the rubber grips on the floor) against the wall when not in use. The rubber handles provide much more friction than the plastic feet, preventing them from sliding and crashing to the floor.
Pro tip: Keep a pair of crutches by your bed so you can safely get up during the night.
Blood Clot Prevention - A Critical Concern
Why Clot Risk is Higher After an Achilles Rupture
This is one of the most important sections of this guide. Achilles tendon rupture carries a significantly higher risk of blood clots (venous thromboembolism or VTE) compared to other injuries.
The Statistics Are Stark
Why is the risk so high?
- Immobilisation reduces blood flow in your leg
- The injury itself causes inflammation near the deep veins
- You're less mobile overall
- The calf muscle pump that normally helps move blood isn't working effectively
Blood Thinners: Injections vs Tablets
Your doctor will likely prescribe blood-thinning medication (thromboprophylaxis) to reduce your clot risk.
- The traditional approach
- Self-injected into your stomach area
- Effective but inconvenient for the 6+ weeks of immobilisation
- Can cause bruising at injection sites
- Newer approach gaining popularity
- Once-daily tablet - much more convenient
- Whether tablets are appropriate depends on your personal risk/bleeding profile and local protocol
Talk to your medical team about which option is best for you. The key is that you take something - the risk is too high to ignore.
Warning Signs to Watch For
Learn to recognise the symptoms of a blood clot. Seek immediate medical attention if you experience:
- Pain or tenderness in the calf or thigh (beyond normal injury pain)
- Swelling in the leg, ankle, or foot (more than expected)
- Redness or warmth in the affected area
- Leg feeling unusually heavy
- Sudden shortness of breath
- Chest pain (especially when breathing deeply)
- Coughing up blood
- Rapid or irregular heartbeat
- Feeling faint or lightheaded
What's Normal This Week (And What Needs Urgent Help)
The hardest part of Week 1 is not knowing what's "normal". Use this as a quick filter.
- Pain that's worst at the moment of injury, then settles over hours/days
- Swelling/bruising that increases over the first 24-72 hours
- Warmth around the ankle (mild) and a heavy/tired feeling from immobility
- Disrupted sleep from the cast/splint/boot
- "Weird" sensations (tightness, tingling that improves when you change position)
- New calf pain/tenderness, one-leg swelling, redness/warmth in the calf (possible DVT)
- Chest pain, breathlessness, coughing blood, fainting (possible PE)
- Numb foot/toes, blue/pale toes, or severe increasing pain (circulation/pressure problem)
- Fever, rapidly spreading redness, or discharge (possible infection)
- A fall with a new "pop", sudden loss of function, or sudden severe pain
Practical Survival Tips for Week 1
Setting Up Your Recovery Station at Home
Before you leave the hospital (or as soon as you get home), think about creating a recovery base. Ideally on the ground floor if you have stairs.
- A comfortable chair or sofa with space to elevate your leg
- Pillows or a wedge to elevate your foot above heart level
- Side table within arm's reach for: water bottle, medications, phone and charger, remote controls, snacks
- Crutches positioned for easy access
- Clear pathways to the bathroom
- Move essential toiletries to an accessible height
- Consider a shower stool or chair
- Non-slip mat inside the shower/bath
- Handheld shower head if possible
Elevation - Why 23 Hours/Day Matters Initially
In the first week, elevation is critical. Some protocols recommend keeping your ankle above heart level for up to 23 hours per day initially, then 12 hours per day in week two.
Why elevation matters:
- Reduces swelling significantly
- Improves blood flow to the healing area
- Decreases pain and discomfort
- Helps deliver nutrients for healing
How to elevate properly:
- Your ankle should be above the level of your heart
- Simply putting your foot on a coffee table isn't enough
- Lie down with pillows under your calf and ankle
- Or use a specialised leg elevation wedge
The Ice Protocol
Ice helps reduce swelling and can provide pain relief in the first few days.
- Apply ice for 20-30 minutes on, then 30 minutes off
- Always use a towel or cloth between the ice and your skin
- Focus on the first 3-4 days post-injury
- Don't ice directly over a plaster cast (it won't penetrate anyway)
- If you have a removable splint, you can ice the ankle area
Note: After the first few days, ice becomes less important. Focus on elevation and rest.
Sleeping in Week 1 (Spoiler: It's Hard)
Let's be honest - sleeping with a leg in a cast or splint is challenging. Your foot must remain protected 24/7, which means wearing your immobilisation device to bed.
Common sleep challenges:
- The cast/splint/boot is heavy and uncomfortable
- You can't move freely
- Your foot may feel hot and sweaty
- Finding a comfortable position is difficult
- You may need to get up to use the bathroom
Tips for better sleep:
- Use extra pillows to support your leg in a comfortable position
- Keep your injured leg elevated even while sleeping (pillow under the calf)
- Wear loose, comfortable clothing
- Keep the room cool to compensate for the warm cast/boot
- Keep crutches right next to your bed
- Use a nightlight so you can see if you need to get up
- Consider sleeping slightly propped up rather than flat
For Boot Wearers
Many patients find sleeping in a walking boot extremely uncomfortable. Later in your recovery (typically from week 2-4 onwards, with specialist approval), you may be able to use a night splint designed specifically for Achilles rupture. This is lighter and more comfortable than a boot while still protecting your tendon.
Questions to Ask at A&E / Fracture Clinic
If you can, write these down on your phone and bring them to your appointment.
- Diagnosis: "Is this a confirmed rupture? Do I need ultrasound?"
- Position: "What ankle angle should I be in (how pointed-down) and for how long?"
- Weight-bearing: "Am I non-weight-bearing, partial, or weight-bearing as tolerated?"
- Clot prevention: "Am I getting VTE prophylaxis? For how long? What symptoms should trigger urgent help?"
- Follow-up: "When is my fracture clinic/orthopaedics appointment, and who do I contact if it hasn't been booked?"
- Hygiene: "Can I remove anything to wash/shower, or should I use a waterproof cover only?"
- Work note: "Can you provide a fit note/sick note today?"
Essential Purchases for Week 1
Here are the items that will make your first week significantly more manageable.
Usually Provided by the Hospital
- Crutches
- Initial immobilisation (cast, splint, or boot)
- Blood thinning medication prescription
Worth Purchasing
| Item | Why You Need It |
|---|---|
| Waterproof Cast/Boot Cover | Essential for showering safely |
| Leg Elevation Wedge/Pillow | Much better than stacking regular pillows |
| Ergonomic Crutch Handle Covers | Your hands will thank you (not essential in week 1 but helpful) |
For Later (But Worth Ordering Now)
| Item | Why You Need It |
|---|---|
| Night Splint | For sleeping without the boot (typically from week 2-4) |
| Shoe Leveler (EVENup) | Prevents back pain when walking in a boot |
What's Coming Next - Preparing for Weeks 1-3
Specialist Appointment Timeline
In the UK NHS system, you'll typically be seen by a specialist within 1-3 weeks. In some areas with dedicated pathways (like hospitals using the Thetis Trauma Splint), this can be under a week.
At your specialist appointment, expect:
- A detailed physical examination
- Possibly an ultrasound scan to assess the tendon
- A discussion about treatment options (surgery vs non-surgical)
- Fitting of a walking boot if you don't have one already
- A rehabilitation plan
Treatment Decision Upcoming
The big question you'll face in weeks 1-3 is: surgery or no surgery?
The Good News
Surgery may be considered if:
- There's a significant gap between the tendon ends (seen on ultrasound)
- You're a high-level athlete with specific demands
- You have other factors that make non-surgical treatment less suitable
Non-surgical treatment involves:
- Wearing a walking boot with wedges for approximately 10 weeks
- Gradual reduction in the foot angle over time
- Physiotherapy starting around weeks 9-12
- Full recovery taking 6-12 months
Don't worry about making this decision now. Focus on surviving Week 1, and you'll discuss options with your specialist soon.
FAQs for Week 1
Summary: Your Week 1 Checklist
- Keep your foot immobilised 24/7 in the cast/splint/boot provided
- Take blood thinning medication as prescribed
- Elevate your leg above heart level as much as possible
- Use ice for the first 3-4 days to reduce swelling
- Take pain medication as needed
- Set up a recovery station at home
- Learn to use your crutches safely
- Order a waterproof cover for showering
- Know the warning signs of blood clots
- Rest - your body is healing
References
UK-FATE audit — "Incidence of venous thromboembolism following Achilles tendon rupture. Data from the UK foot and ankle thrombo-embolism (UK-FATE) audit." PMID: 39961162
Maffulli N, et al. "The clinical diagnosis of subcutaneous tear of the Achilles tendon. A prospective study in 174 patients." PMID: 9548122
NICE guideline NG89 — "Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism."
Costa ML, et al. "Plaster cast versus functional brace for non-surgical treatment of Achilles tendon rupture (UKSTAR)." PMID: 32035553
