Achilles Tendon Injuries

If foot discomfort intensifies, interrupts daily activities, or is associated with swelling and redness, it is crucial to consult a healthcare professional. At Complete Orthopedics, our expert team is committed to treating posterior cruciate ligament injuries using tailored approaches and surgical procedures. We strive to understand your symptoms, identify the underlying causes, and recommend suitable treatments or surgeries.

Our facilities are spread across New York City and Long Island, connected to six top hospitals, ensuring access to exceptional foot care. You can schedule an appointment with our orthopedic specialists online or by phone. Learn about the causes and treatments for foot pain and discover when surgical intervention is the best option.

Overview

The Achilles tendon is located in the lower back of the leg. It is the largest and the thickest tendon of the body. Injuries to the Achilles tendon are common among athletes and nonathletes alike.

A tendon injury may result in complete rupture or tears of the tendon. Chronic overuse while running and jumping may result in inflammation of the tendon.

X-ray showing the normal soft tissue shadow of Achilles tendon.

X-ray showing the normal soft tissue shadow of Achilles tendon.

The Achilles tendon connects the calf muscles with the heel bone (calcaneum). The tendon helps the calf muscles to flex the foot. The foot is pressed against the ground to produce counter force. This action is utilized in walking, running, and a variety of other activities such as jumping and walking tiptoed.

 

Common Types of Achilles Tendon Injuries

There are several types of injuries that can affect the Achilles tendon:

Tendinitis: This is inflammation of the tendon, usually caused by repetitive stress or sudden increases in physical activity. It can cause pain, swelling, and stiffness.

Tendinosis: This is a chronic condition where the tendon degenerates and becomes weak due to long-term overuse.

Tears and Ruptures: These occur when the tendon fibers tear partially or completely, often due to a sudden, forceful movement.

 

Causes of Achilles Tendon Injuries

Achilles tendon injuries can result from various factors, including:

  • Overuse: Repetitive stress from activities like running or jumping.
  • Sudden Increase in Activity: Increasing the intensity or duration of your physical activity too quickly.
  • Improper Footwear: Wearing shoes that do not provide adequate support.
  • Tight Calf Muscles: Lack of flexibility in your calf muscles can strain the Achilles tendon.
  • Age and Gender: Middle-aged men are more prone to these injuries.
  • Certain Medications: Some medications, such as certain antibiotics, can increase the risk of tendon problems.

 

Causes of Tendon Rupture

The Achilles tendon is susceptible to rupture in the age groups of 30 – 40 years old. The cause may be violent or even minor trauma. The tendon bears constant wear and tear from day to day activities.

  • Diabetics and Obesity are risk factors for tendon tear or rupture with minor trauma.
  • Steroid injection given in the ankle makes the tendon more prone to rupture.
  • Antibiotics such as fluoroquinolones may also result in Achilles tendon rupture due to side effects.
  • Fall from height landing and landing with a straight knee commonly injures the tendon.
  • The accidental forceful upper movement of the foot can lead to rupture.
  • High impact activities such as jumping and sports such as softball, basketball, track, and field may result in tendon injuries.
  • A sudden increase in training or tight calf muscles may also result in Achilles tendon injuries.
  • Sharp injuries to the back of the lower leg may result in tendon injuries.

The Achilles tendon usually ruptures an inch or two above the insertion in the heel. This because the area relatively receives less blood supply.

Symptoms

The symptoms of Achilles tendon injuries are sudden pain with swelling. The patient may report a loss of function of the involved leg.

The patient is unable to walk tiptoed and has decreased strength. There may be associated swelling just above the heel. The patients report to hear a pop or snapping sound at the time of the rupture.

Achilles tendonitis is the inflammation of the tendon fibers. The symptoms are usually pain and swelling above and around the heel. The pain is usually less in intensity compared to tendon rupture.

 

Diagnosis

The diagnosis of Achilles tendon injuries is best made by an orthopedist. The physician will take a detailed history of the events leading to injury. The physical examination included an examination of the swelling and tender points. Special tests are done to check the integrity of the tendon such as squeezing the calf muscles to look for foot movements.

The radiological examination includes an X-ray to look for any associated fractures and the clear space behind the shin bone. An ultrasound will usually detect tendon tear and the gap between the two ends. MRI can provide a detailed view of the torn or ruptured tendon.

 

Treatment

The management of inflamed tendon is usually conservative with rest, icing, compression and elevation, and sometimes splints. Nonsteroidal anti-inflammatory drugs NSAIDs may be used to reduce pain and swelling.

Minor tears of the tendon heal on their own and do not require any surgical intervention. The affected leg may be placed in a cast/splint to allow adequate rest to the tendon while it heals.

Torn Achilles tendon with a significant gap between the tendon requires surgical repair. Both open and minimally invasive techniques may be used to repair the torn tendons. Old ruptured tendons with significant gaps often require an additional graft to repair the tendon.

 

Recovery

After the surgery, the lower leg along with the foot is placed in a cast. The cast is changed after a few weeks to a more neutral position. After the cast is cut in 6-8 weeks, the walking boot is used and physical therapy is started. The physical therapy is aimed to strengthen the muscles and increase range of motion.

 

Preventing Achilles Tendon Injuries

To prevent these injuries, consider the following tips:

  • Gradual Increase in Activity: Avoid sudden increases in physical activity.
  • Proper Footwear: Wear shoes that provide good support.
  • Stretching and Strengthening: Regularly stretch and strengthen your calf muscles.
  • Listen to Your Body: Avoid pushing through pain or discomfort during exercise.

 

Conclusion

Achilles tendon injuries are common but manageable with proper care and treatment. By understanding the causes, symptoms, and treatment options, you can take steps to prevent these injuries and ensure a swift recovery if they occur. Remember to seek professional medical advice if you suspect an Achilles tendon injury and follow recommended rehabilitation protocols for the best outcomes.

Do you have more questions? 

What are the non-surgical treatments for Achilles tendon injuries?

Non-surgical treatments include rest, ice, compression, elevation (RICE), anti-inflammatory medications, physical therapy, and orthotic devices such as heel lifts or supportive footwear.

When is surgery necessary for an Achilles tendon injury?

Surgery is typically necessary for complete ruptures, especially in active individuals who want to return to high levels of activity. It may also be considered if non-surgical treatments fail to improve symptoms.

Can Achilles tendon injuries be prevented?

While not all injuries can be prevented, reducing risk factors can help. This includes gradually increasing activity levels, wearing proper footwear, stretching, and strengthening calf muscles, and avoiding sudden increases in physical activity.

What are the risks of Achilles tendon surgery?

Risks include infection, nerve damage, blood clots, and complications related to anesthesia. There is also a risk of re-rupture or incomplete healing.

How effective is physical therapy for Achilles tendon injuries?

Physical therapy is highly effective for both non-surgical and post-surgical rehabilitation. It helps restore strength, flexibility, and function to the affected tendon.

Can Achilles tendon injuries recur?

Yes, there is a risk of recurrence, especially if proper rehabilitation and preventative measures are not followed. Strengthening exercises and gradual return to activity can help reduce this risk.

Are there any long-term effects of an Achilles tendon injury?

Some individuals may experience long-term effects such as chronic pain, stiffness, or reduced strength in the affected leg. Proper rehabilitation and adherence to treatment can minimize these effects.

How do I know if my Achilles tendon injury is getting worse?

Signs of worsening include increased pain, swelling, difficulty moving the foot or ankle, and new symptoms such as numbness or tingling. Consult a healthcare professional if you experience these symptoms.

What role do orthotic devices play in treating Achilles tendon injuries?

Orthotic devices, such as heel lifts or supportive shoes, can help reduce strain on the Achilles tendon, alleviate pain, and support healing during recovery.

Can I continue to exercise with an Achilles tendon injury?

It is important to rest and avoid activities that aggravate the injury. Low-impact exercises such as swimming or cycling may be permitted, but always consult with a healthcare provider before resuming any exercise.

What is the difference between Achilles tendinitis and tendinosis?

Tendinitis is the acute inflammation of the tendon due to overuse or sudden increase in activity. Tendinosis is a chronic condition characterized by degeneration and thickening of the tendon without significant inflammation.

How can I stretch my Achilles tendon safely?

Safe stretches include calf stretches, such as the wall stretch where you lean against a wall with one leg forward and the injured leg extended back, keeping both heels on the ground. Hold the stretch for 20-30 seconds and repeat several times daily.

What kind of doctor should I see for an Achilles tendon injury?

An orthopedic surgeon or a sports medicine specialist is typically the best choice for diagnosing and treating Achilles tendon injuries.

How soon can I return to sports after an Achilles tendon injury?

The timeline varies based on the severity of the injury and the treatment received. Generally, it can take several months to a year to return to sports. A gradual return under the guidance of a healthcare professional is crucial.

Are there any specific exercises to strengthen the Achilles tendon?

Yes, eccentric heel drops, where you slowly lower your heel below a step level, are particularly effective. Other exercises include calf raises and resistance band exercises for the ankle.

Can Achilles tendon injuries affect other parts of the leg?

Yes, compensating for the injury can lead to issues in other parts of the leg, such as the knee, hip, or opposite ankle, due to altered gait or movement patterns.

How does age affect the risk of Achilles tendon injuries?

Age increases the risk because tendons lose elasticity and strength over time, making them more susceptible to injury. Middle-aged individuals are particularly at risk.

What should I do if I suspect an Achilles tendon rupture?

Seek immediate medical attention. Avoid putting weight on the affected leg and keep it elevated. Ice can help reduce swelling until you receive professional care.

How do anti-inflammatory medications help with Achilles tendon injuries?

These medications can reduce pain and swelling associated with inflammation, making it easier to move the affected area and participate in physical therapy

What are the benefits of early mobilization after Achilles tendon surgery?

Early mobilization can improve healing, reduce stiffness, and help restore function more quickly. However, it should be done under the guidance of a healthcare professional to avoid complications.

How can diet impact the healing of an Achilles tendon injury?

A diet rich in protein, vitamins C and E, and minerals like zinc and magnesium can support tissue repair and reduce inflammation, promoting faster healing.

Are there any advanced treatments for Achilles tendinosis?

Advanced treatments include platelet-rich plasma (PRP) injections, extracorporeal shockwave therapy (ESWT), and minimally invasive procedures to remove damaged tissue and stimulate healing.

Can poor circulation affect Achilles tendon healing?

Yes, poor circulation can delay healing by reducing the delivery of oxygen and nutrients to the injured tendon. Ensuring good circulation through appropriate medical care and lifestyle changes can aid recovery.

Suhirad-Khokhar-MD

My name is Dr. Suhirad Khokhar, and am an orthopaedic surgeon. I completed my MBBS (Bachelor of Medicine & Bachelor of Surgery) at Govt. Medical College, Patiala, India.

I specialize in musculoskeletal disorders and their management, and have personally approved of and written this content.

My profile page has all of my educational information, work experience, and all the pages on this site that I've contributed to.