Foot & Ankle Tendon Tears: Diagnosis & Treatment | Podiatrist 2026

Tendon tears in the foot and ankle are more common than most people realize — and are more commonly misdiagnosed as ‘sprains’ or ‘strains’ that are expected to heal on their own. The problem is that tendons don’t receive a reliable blood supply, heal slowly, and when a complete tear occurs, the tendon ends retract and cannot reattach without surgery. At Balance Foot & Ankle, we use ultrasound and MRI to distinguish partial from complete tears and have clear protocols for each.

Achilles Tendon Tears

Complete Achilles Rupture

The Achilles tendon is the strongest tendon in the body, but also the most frequently ruptured. Complete rupture typically occurs in the ‘watershed zone’ 2–6cm above the calcaneal insertion, during sudden eccentric loading (pushing off from a planted foot in sports, or stepping off a curb).

The hallmark signs are: a sudden ‘pop’ felt or heard, immediate inability to push off, a palpable gap in the tendon, and a positive Thompson test (squeezing the calf produces no ankle plantarflexion). Treatment options:

• Surgical repair: End-to-end tendon suture through a posteromedial incision. Allows earlier functional rehabilitation. Preferred for active, younger patients, athletes, and bilateral cases. Re-rupture rate 2–5%.
• Non-surgical (functional bracing): Progressive weight-bearing in a plantarflexed boot with serial reduction of plantarflexion over 8–12 weeks. Modern accelerated rehabilitation protocols achieve re-rupture rates of 8–12% — higher than surgery but with no surgical complications. Appropriate for sedentary patients, older patients, and those with high surgical risk.
• Recovery: Return to sport typically 9–12 months regardless of treatment method.

Partial Achilles Tears

Partial tears manifest as focal tendon thickening, a painful nodule, and failure to respond to standard tendinopathy management. MRI or ultrasound confirms the defect. Treatment: 6–12 weeks immobilization, heel lift, eccentric exercise protocol, PRP injection. Surgery for refractory cases — intratendinous debridement with or without augmentation.

Posterior Tibial Tendon Tears

The posterior tibial tendon (PTT) is the primary dynamic arch support of the medial foot. Tears occur almost exclusively via degeneration (tendinopathy → partial tear → complete tear) rather than acute injury. The classic patient is a middle-aged woman with a new progressive flatfoot on one side.

• Stage I (tendinopathy, intact tendon): Medial ankle pain; foot still supinates on single-leg heel rise; treated with immobilization + orthotics + PT
• Stage II (partial tear, flexible flatfoot): Cannot complete single-leg heel rise; flatfoot flexible (corrects with toe raise); treated with custom UCBL orthosis or AFO + possible tenosynovectomy
• Stage III (complete tear, rigid flatfoot): Fixed flatfoot deformity; surgical reconstruction needed — FDL tendon transfer + calcaneal osteotomy
• Stage IV: Ankle valgus involved — requires triple arthrodesis or TAR + flatfoot reconstruction

Peroneal Tendon Tears

The peroneal tendons (peroneus brevis and longus) run behind the lateral malleolus. Brevis tears are more common, occurring at the fibular groove as the tendon is compressed against the bone during inversion stress. Longitudinal ‘split tears’ are the characteristic pattern.

• Symptoms: Lateral ankle pain posterior to the fibula, swelling in the peroneal groove, pain with resisted eversion, tenderness behind the lateral malleolus
• Peroneal subluxation: The superior peroneal retinaculum tears, allowing the tendons to snap over the fibular tip — the patient feels and sometimes hears the snapping with ankle motion
• Conservative treatment: Immobilization in a boot for 4–6 weeks for partial tears; custom ankle brace for subluxation if patient declines surgery
• Surgical treatment: Debridement + tubularization of split brevis tears; superior peroneal retinaculum repair for subluxation; FHL transfer for longus tears with symptomatic os peroneum

Other Foot Tendon Tears

• Flexor hallucis longus (FHL) partial tear: Posterior ankle pain + triggering great toe; common in dancers; treated with FHL stretching, orthotics, or endoscopic release
• Extensor hallucis longus (EHL) complete rupture: Inability to extend the big toe after direct trauma to the dorsum; requires primary surgical repair within 2 weeks to prevent retraction
• Tibialis anterior rupture: Foot drop + inability to dorsiflex; acute repair if < 6 weeks old; tendon transfer for chronic cases

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Diagnosis of Tendon Tears

• Clinical examination: Thompson test (Achilles), single-leg heel rise (PTT), resisted eversion (peroneal), dorsal drawer (plantar plate) — physical examination alone has high sensitivity for complete tears
• Ultrasound: Dynamic imaging that shows partial vs. complete tear, tendon sheath fluid, subluxation in real time. Highly cost-effective first-line imaging.
• MRI: Gold standard for precise tear characterization, muscle belly atrophy (indicating chronicity), and surgical planning
• X-ray: Rules out avulsion fractures and bony pathology; an os peroneum fracture indicates peroneus longus rupture at its sesamoid

Frequently Asked Questions

How do you know if you’ve torn a tendon in your foot?

Key signs of a significant tendon tear: a sudden ‘pop’ at the moment of injury, immediate functional loss specific to that tendon (inability to push off = Achilles; inability to invert/supinate = PTT; inability to evert = peroneal), a palpable gap in the tendon, and swelling localized to the tendon course. If any of these are present, imaging is mandatory to rule out a complete tear.

Can foot tendons heal without surgery?

Partial tendon tears often heal with conservative treatment — immobilization, protected weight-bearing, and rehabilitation over 6–12 weeks. Complete tears of major tendons (Achilles, PTT) generally do not heal without surgery because the tendon ends retract and develop scar tissue that prevents adequate tension restoration. Non-operative Achilles rupture treatment is an exception but requires a strict accelerated rehabilitation protocol.

How long does a tendon tear take to heal?

Partial tears: 6–12 weeks for return to activity. Complete rupture with surgical repair: return to sport 9–12 months. Complete Achilles rupture treated non-operatively: return to light activity 4–6 months, full sport 9–12 months. Posterior tibial tendon reconstruction: 6–12 months depending on extent of reconstruction.

What is the difference between a tendon tear and tendonitis?

Tendonitis (or tendinopathy) is degeneration and inflammation of an intact tendon — painful but without structural failure. A tendon tear is a partial or complete disruption of the tendon fibers. Tendinopathy is managed with activity modification and rehabilitation; a complete tear usually requires surgical intervention. Partial tears occupy the middle ground.

Is PRP effective for tendon tears?

Platelet-rich plasma (PRP) has the strongest evidence for partial tendon tears where the tendon is intact but degenerated. Multiple randomized trials show improved outcomes for partial Achilles and patellar tendon injuries compared to sham injection. For complete tendon ruptures, PRP is sometimes used as an adjunct to surgical repair to enhance healing, but it is not a substitute for surgery.

Sources

Dr. Tom Biernacki, DPM

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Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.