Achilles Tendon Injury

What is an Achilles tendon injury?

The Achilles tendon connects the heel bone to the calf muscle of the leg. Injury to the tendon may cause it to become inflamed or torn. It lets you point your toes up and down and walk by putting your heel down first and then your toes.

Tendons are strong bands of connective tissue that attach muscle to bone. When a tendon is acutely injured it is called a strain. Achilles tendinopathy is an injury to your Achilles tendon from overuse. Tendonitis is when a tendon is inflamed. When there are micro-tears in a tendon from repeated injury it is called tendinosis. Tendinopathy is the term for both inflammation and micro-tears. This causes pain at the back of your leg by the heel.

How does it occur?

Achilles tendinopathy can be caused by:

• overuse of the Achilles tendon
• tight calf muscles
• tight Achilles tendons
• lots of uphill running
• increasing the amount or intensity of sports training, sometimes along with switching to racing flats, which are racing shoes with less heel lift
• over-pronation, a problem where your feet roll inward and flatten out more than normal when you walk or run
• wearing high heels at work and then switching to lower-heeled shoes for exercise

An Achilles tendon may tear during sudden activity. For example the tendon might tear when you jump or start sprinting.

What are the symptoms?

Achilles tendinopathy causes pain and may cause swelling over the Achilles tendon. The tendon is tender and may be swollen. You will have pain when you rise up on your toes and pain when you stretch the tendon. The range of motion of your ankle may be limited.

When the tendon tears or ruptures, you may feel a pop. If there is a complete tear, you will be unable to lift your heel off the ground or point your toes.

How is it diagnosed?

Your healthcare provider will examine your leg, looking for tenderness and swelling. Your provider will watch your feet when you walk or run to see if you over-pronate.

How is it treated?

To treat this condition:

• Put an ice pack, gel pack, or package of frozen vegetables, wrapped in a cloth on the area every 3 to 4 hours, for up to 20 minutes at a time.
• You could also do ice massage. To do this, first freeze water in a Styrofoam cup, then peel the top of the cup away to expose the ice. Hold the bottom of the cup and rub the ice over your tendon for 5 to 10 minutes. Do this several times a day while you have pain.
• Raise your foot by putting a pillow under your lower leg when you sit or lie down.
• Take an anti-inflammatory such as ibuprofen, or other medicine as directed by your provider. Nonsteroidal anti-inflammatory medicines (NSAIDs) may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take for more than 10 days.
• While you are recovering from your injury, change your sport or activity to one that does not make your condition worse. For example, you may need to swim instead of run.
• Follow your provider’s instructions for doing exercises to help you recover.
• After you recover from your acute injury, use moist heat for 10 to 15 minutes at a time before you do warm-up and stretching exercises. Do not use heat if you have swelling.
• If you over-pronate, your healthcare provider may recommend shoe inserts, called orthotics, to keep your foot stable. You can buy orthotics at a pharmacy or athletic shoe store or they can be custom-made. If your healthcare provider prescribes a heel lift insert for your shoe, wear it at least until your tendon heals and possibly longer. The lift prevents extra stretching of your Achilles tendon.
• In some severe cases of Achilles tendonitis, your foot may be put in a cast for several weeks.
• A tear of the tendon may require surgery. If you don't have surgery, your foot may be put in a cast for 6 to 10 weeks.

How long will the effects last?

The length of recovery depends on many factors such as your age, health, and if you have had a previous injury. Recovery time also depends on the severity of the injury. A tendon that is only mildly inflamed and has just started to hurt may improve within a few weeks. A tendon that is significantly inflamed and may have many tiny tears that has been painful for a long time may take up to a few months to improve. You need to stop doing the activities that cause pain until the tendon has healed. If you continue doing activities that cause the tendon pain, your symptoms will return and it will take longer to recover.

When can I return to my normal activities?

Everyone recovers from an injury at a different rate. Return to your activity depends on how soon your Achilles tendon recovers, not by how many days or weeks it has been since your injury has occurred. In general, the longer you have symptoms before you start treatment, the longer it will take to get better. The goal of rehabilitation is to return you to your normal activities as soon as is safely possible. If you return too soon you may worsen your injury.

You may safely return to your normal activities when, starting from the top of the list and progressing to the end, each of the following is true:

• You have full range of motion in the injured leg compared to the uninjured leg.
• You have full strength of the injured leg compared to the uninjured leg.
• You can walk straight ahead without pain or limping.

How can I prevent Achilles tendinopathy?

The best way to prevent Achilles tendon injury is to stretch your calf muscles and Achilles tendons before exercise. If you have tight Achilles tendons or calf muscles, stretch them twice a day whether or not you are doing any sports activities that day.

If you have a tendency to get Achilles tendinopathy, try to avoid running uphill.