What are Achilles tendon injuries?

The Achilles tendon is a fibrous band of tissue that links the muscles in your calf to your heel. The strength and flexibility of this tendon are important for jumping, running, and walking. Your Achilles tendon withstands a lot of stress and pressure during everyday activities, as well as during athletic and recreational play.  If it becomes inflamed, swollen, and irritated, it is called tendonitis.

What causes Achilles tendon injuries?

Tendonitis

Tendonitis might be due to overuse or damage to the area. It can cause pain down the back of your leg and around your heel. You might notice that parts of your tendon are getting thicker, and hardening, because of tendonitis. This will get worse if you don't treat it. There are 2 main types of tendonitis:

• Non-insertional Achilles tendonitis. Small tears in the middle fibers of your tendon start to break it down. This causes pain and swelling. This type of tendonitis usually affects active, younger adults

• Insertional Achilles tendonitis. This damage occurs in the spot where your tendon meets your heel bone. Bone spurs (extra bone growth) often form with this type. This type of tendonitis can happen at any age, even in people who are not active.

Rupture

The tears in your tendon fibers can cause a complete or partial break (or tear) in your tendon. You might hear a “pop” that seems to come from the back of your heel or calf. This may be a tendon rupture, which needs immediate medical attention.

Achilles Tendinosis: Q&A with Dr. Nigel Hsu

Key points about Achilles tendon injuries

• Your Achilles tendon can develop tendonitis. This is when it becomes inflamed, swollen, and irritated.

• The Achilles tendon can also tear or rupture, which might sound like a “pop” that seems to come from the back of your heel or calf. This needs immediate medical attention.

• Anyone can develop an Achilles tendon injury and it’s often linked to repetitive stress on the tendon.

• Achilles tendon injuries often cause pain, stiffness, and swelling in the back of your leg near your heel.

• Achilles tendon injuries can be treated with rest and medicines to help with the inflammation. Exercises often help too. If needed, surgery can be done to repair the tendon.

• You can help prevent these injuries by doing things like increasing activity slowly, wearing the correct shoes for your activities, and not exercising on uneven surfaces.

What are the risk factors for Achilles tendon injuries?

Anyone can develop an Achilles tendon injury. They’re often linked to repetitive stress. The most common risk factors are:

• Increased amount or intensity of an activity or sport

• Starting a new sport

• Tight calf muscles when starting an exercise or sport, this can place more stress on your tendon

• Bone spurs on your heel, which can rub against the tendon

• Wearing the wrong shoes when you exercise

• Exercising on an uneven surface

• Treatment with fluoroquinolone, an antibiotic

What are the symptoms of an Achilles tendon injury?

Common symptoms of tendon injuries include:

• Pain down the back of your leg or near your heel

• Pain that gets worse when you're active

• A stiff, sore Achilles tendon when you first get up

• Pain in the tendon the day after exercising

• Swelling with pain that gets worse as you're active during the day

• Thickening of your tendon

• Bone spurs on the heel bone

• Difficulty flexing the affected foot

• A “pop” sound and sudden sharp pain, which suggests a ruptured tendon

How is an Achilles tendon injury diagnosed?

Injury to the Achilles tendon causes pain along the back of your leg near the heel. Sometimes healthcare providers misdiagnose Achilles tendon injuries as a sprained ankle. It’s important to get the right diagnosis so you can get the right treatment. Several common injuries can make your Achilles tendon painful or prevent it from working well.

To diagnose your condition, your doctor will consider:

• Your overall health and medical history

• A description of your symptoms

• A physical exam of your Achilles tendon to check for bone spurs, pain, and swelling

• A test of your ankle's range of motion (ability to move as it should)

• Imaging tests, such as X-ray or magnetic resonance imaging (MRI). An X-ray shows bones and can show if the tendon has become calcified or hardened, and can show bone spurs. Your doctor will use MRI most often to see how severe the tendon damage is and what treatment is best for you.

How are Achilles tendon injuries treated?

Treatment depends on how badly injured your tendon is. It may include:

• Rest

• Ice

• Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief (such as, ibuprofen or naproxen)

• Specific exercises to strengthen your calf muscles

• Physical therapy

• A system of exercises that help strengthen your calf muscles to take the pressure off your tendon (eccentric strength training).

• Low-impact exercise alternatives, such as swimming

• Heel lifts in shoes, orthotic shoes, cast, splint, or a walking boot

• Extracorporeal shockwave therapy: High-energy shockwave impulses help stimulate the healing process in damaged tendon tissue. This treatment isn’t often used, but your doctor may recommend it to see whether you can improve without surgery.

If these do not work, or if the injury is severe or complete, surgery may be considered. The type of surgery depends on the location and amount of damage to the tendon and other factors, such as the severity of the tendonitis. Some of the surgical procedures used include:

• Surgery to lengthen your calf muscles (this is called gastrocnemius recession)

• Debridement surgery to remove damaged tendon tissue or bone spurs and repair the tendon

• Surgery to remove your damaged tendon tissue, repair the remaining tendon, and give it extra strength by moving another tendon to the heel bone (the tendon moved there is the one that helps the big toe point down)

What are the complications of Achilles tendon injuries?

Complications of an Achilles tendon injury may include:

• Pain, which can be severe

• Difficulty walking or being active

• Deformation of your tendon area or heel bone

• Tendon rupture from reinjury

Other complications can be related to the treatments used for an Achilles tendon injury. For instance,

• Occasionally, cortisone injections can cause the tendon to tear

• Surgery can lead to pain and infection

How can I prevent Achilles tendon injuries?

These steps can help prevent injury to your Achilles tendon:

• Warm-up before exercising or before sports or other repetitive movements.

• Increase activity slowly, rather than all at once.

• Wear the correct shoes for your activities.

• Do not exercise on uneven surfaces.

• Stop activities that cause pain.

• Be aware of the risks of fluoroquinolone and exercise with caution if you’re taking this drug.

How to manage an Achilles tendon injury

• Follow your doctor’s recommendations to get rest and manage pain and swelling.

• Choose alternative ways to be active.

• Try low-impact activities that do not place a lot of stress on your tendon, such as swimming or bicycling, rather than a high-impact exercise like running.

• Always let your doctor know if these strategies don’t help reduce pain, swelling, and loss of function.

When should I call my healthcare provider?

Call your doctor immediately if you hear a “pop” sound and have sudden pain in the back of your leg or heel. Otherwise, schedule an appointment if pain or trouble moving affects your regular daily activities.