Achilles Tendon Injuries

The Achilles tendon is the largest tendon in your body. It connects the muscles in the back of your lower leg to your heel bone (the calcaneus) and must withstand large forces during sporting exercises and pivoting. There are two main types of injuries that affect the Achilles tendon: 1) overuse and inflammation, called Achilles Tendonitis, and 2) a tear of the tendon.

Achilles Tendonitis

Achilles tendonitis often occurs when you rapidly increase the intensity of training or start new types of training when your body is not fully conditioned, e.g., adding uphill running to your training schedule or restarting training after a period of inactivity. You may experience mild pain after exercise that gradually worsens. Mild swelling, morning tenderness, and stiffness may also occur, but may improve with use. Severe episodes of pain along the length of the tendon several hours after exercise may also be experienced. It can also be caused by a trauma to the calf muscle due to extra effort, or overuse due to an inflexibility of the calf muscle.

Because other symptoms may be present, it is best to see your doctor for full evaluation of an Achilles injury. Treatment depends on severity and typically involves rest and nonsteroidal anti-inflammatory medications (NSAIDs) to relieve pain and inflammation. An orthosis (a brace) may be needed to relieve the stress on your tendon and support your ankle, or bandages may be applied to restrict joint movement.

Surgery is sometimes an option to repair any tears and remove any inflamed or fibrous (toughened) tissues. Recovery in general includes rehabilitation to avoid future weakness in your ankle.

Prevention

While you may not be able to avoid Achilles tendonitis altogether, there are certain steps you can take to minimize your risk of injury:

• Know your limits and don’t overdo it when running.
• Choose running that provide adequate heel cushioning. Your doctor may also recommend an orthotic to correct the position of a mis-aligned heel bone.
• Warm up gradually before running, concentrating on stretching the calf muscles
• Increase your distance and speed gradually, no more than 10% a week.
• Avoid irregular strenuous sprinting, stair climbing and other stressful running.
• Always cool down properly after exercise

Repair & Recovery

Achilles tendonitis treatment varies with the degree of the injury. Treatment regimens may include:

• Resting the tending for about a week by not running or exercising, or by shifting to non-impact activities such as swimming.
• Anti-inflammatory medications, such as ibuprofin.
• Orthoses, such as shoe inserts, to help alleviate stress on the tendon.
• Stretching and other exercises to strengthen the muscles in the front of the leg.

Surgery is only an option of last resort in treating Achilles tendonitis.

Achilles Tear

Your Achilles tendon may tear if it is overstretched, usually while playing sports. The tear may be partial or complete and most commonly occurs just above the calcaneus (your heel bone). A snap or crack sound may be heard at the time of injury. Pain and swelling near your heel and an inability to bend your foot downward or walk normally are signs that you may have ruptured your Achilles tendon.

Surgery is typically needed for a complete rupture. After surgery, your ankle will be kept stable in a cast or walking boot for up to 12 weeks. A torn ligament may also be managed nonsurgically with a below-knee cast, which would allow the ends of the torn tendon to heal on their own. This nonsurgical approach may take longer to heal, and there is a higher chance that the tendon could re-rupture. Surgery offers a better chance of full recovery and is often the treatment of choice for active people who wish to resume sports.

If you suspect that you have signs or symptoms of an Achilles tendon injury, please see your doctor for further evaluation and discussion of treatment.