Tendons are fibrous tissues that connect muscles to bone, and the Achilles tendon is the largest and strongest tendon in the body. It connects the calf muscles at the back of the leg to the heel bone and makes movements like walking, running, and jumping possible. Because it is used constantly and bears so much load, it is one of the most commonly injured tendons in the body.
Achilles tendon injuries cause the tissue to become irritated, inflamed, and swollen. Pain can come on gradually or appear suddenly, and its intensity can range from mild stiffness to a severe, disabling injury. Pain location varies too, from just above the heel to further up the back of the leg.
What Causes Achilles Tendon Injuries?
Achilles tendon injuries are most often caused by repetitive stress on the tendon. They commonly occur during running, tennis, gymnastics, football, basketball, dancing, soccer, baseball, or any sport that involves speeding up, slowing down, or pivoting quickly. Sudden increases in training intensity or mileage are a frequent trigger.
Other contributing factors include wearing high heels, falling from a height, stepping into a hole, having flat feet or bone spurs, tight calf muscles or tendons, wearing improper athletic shoes, exercising on uneven surfaces, and starting a new type of exercise too aggressively.
Types of Achilles Tendon Injuries
The two most common Achilles tendon injuries are tendinitis (also called tendinopathy) and ruptures.
Achilles Tendinitis / Tendinopathy
Tendinitis causes painful inflammation and can occur in different parts of the tendon:
- Non-insertional Achilles tendinitis occurs when fibers in the middle of the tendon begin to break down, thicken, and swell. This typically affects younger, more active adults.
- Insertional Achilles tendinitis occurs where the tendon attaches to the heel bone. Bone spurs commonly form alongside this type of injury, and it can affect people of any age or activity level.
Symptoms of tendinitis include dull to severe pain along the back of the heel or lower calf, stiffness that is often worse in the morning or after rest, increased blood flow and warmth around the tendon, and gradual thickening of the tendon itself. Pain typically worsens with activity and improves with rest.
Achilles Tendon Ruptures
A rupture is a tear in the tendon, which may be partial or complete. There is often an audible popping or snapping sound at the moment of injury, followed by sudden, severe pain, extensive swelling, and an inability to bear weight or rise onto the toes.
How Is an Achilles Tendon Injury Diagnosed?
Diagnosing an Achilles tendon injury involves several precise steps to ensure accurate identification and treatment. A podiatrist will first discuss your symptoms, focusing on any sharp pain in the ankle or back of the leg, difficulty walking, or an audible snap at the time of injury.
A thorough physical examination follows, often starting with the Thompson test, in which the podiatrist squeezes the calf muscle while you lie face down. A lack of foot movement in response suggests a tear. Plantar flexion tests assess your ability to flex the foot and rise onto your toes, and visible signs such as a soft spot or bruising near the tendon can also indicate damage.
For a more detailed view, imaging tests may be ordered. An ultrasound provides real-time 2D images useful for pinpointing partial tears, while an MRI offers 3D imaging that is particularly useful for identifying complete ruptures where the tendon ends have separated.
Treatment and Prevention
Depending on the type and severity of the injury, treatment may include:
- Rest, ice, compression, and elevation (RICE)
- Nonsteroidal anti-inflammatory medications
- Heel lifts to reduce tension on the tendon
- Stretching and strengthening exercises
- Physical therapy, ultrasound, or shockwave therapy for more persistent cases
- Immobilization in a boot or cast, or surgery, for a torn tendon
Achilles tendon injuries need prompt attention to avoid complications like chronic tendinopathy or a complete rupture. Several preventative measures can also reduce your risk:
- Thorough stretching of the calf and Achilles tendon before and after exercise
- Strengthening exercises such as calf raises, squats, leg curls, leg extensions, leg raises, lunges, and leg presses
- Increasing training volume gradually rather than all at once
- Wearing supportive, well-fitting athletic shoes appropriate for your activity
If you suspect an Achilles tendon injury, it is suggested that you make an appointment with a podiatrist promptly for a diagnosis and treatment plan. If you have any concerns, contact Vivian C. Iwu, DPM of Choice Podiatry Center. Our doctor offers the newest diagnostic tools and treatment technologies to keep you pain-free and on your feet. If you have any questions, feel free to contact our office located in Marietta, GA.
Request an appointment today to have your Achilles tendon pain properly evaluated.