What is the Achilles tendon?
The Achilles tendon is the largest, strongest tendon in the human body. Tendons are long, tough cords of tissue that connect muscle to bone. The Achilles tendon is located in the back of the heel and connects the heel bone to the calf muscle. It helps a person walk, run and jump. The Achilles tendon is able to endure stress, but sometimes injury can occur to the tendon when it is overly stressed.
What is Achilles tendinitis?
Overuse of the Achilles tendon may cause the tendon to swell, become irritated, inflamed, and painful. This is Achilles tendinitis. It is a common sports injury that is related to running, but it can happen to anyone who puts a lot of stress on their feet (e.g., basketball players and dancers). If one does not get treatment for Achilles tendinitis, the problem can become chronic (long-term) and make it difficult to walk.
What is an Achilles tendon rupture?
In an Achilles tendon rupture, the tendon that connects the heel bone to the calf muscle tears and the fibers separate. This happens mostly to people between the ages of 30 and 50, and usually is caused by sports activity.
Symptoms and Causes
What causes Achilles tendinitis?
Achilles tendinitis is caused by a great deal of stress on the feet. It is a common athletic injury. Things that can cause tendinitis include:
- Pushing the body too fast and too soon
- A sudden increase in activity
- Sports that have quick starts and stops
- Poor fitting shoes/bad footwear
- Injury to the Achilles tendon
- Running or exercising on uneven ground
- Running uphill
- Tight calf muscles
- Bone spur (extra bone growth in the heel that rubs the tendon and causes pain)
- Flat arches, feet that roll in (overpronation), and weak calf muscles
- Not warming up before exercising
What are the symptoms of Achilles tendinitis?
Common symptoms of Achilles tendinitis include:
- Weakness in the leg
- Slight pain in the lower leg above the heel after activity
- Feeling of stiffness in the leg that usually appears in the morning and lessens throughout the day
- Bad pain the day after exercising
- Pain as you climb stairs or go uphill
- Swelling in the area of the Achilles tendon
What causes an Achilles tendon rupture?
The causes of an Achilles tendon rupture are very similar to those of Achilles tendinitis. Causes include:
- Running uphill;
- Running on a hard surface;
- Quickly changing speeds from walking to running;
- Playing sports that cause you to quickly start and stop.
What are the symptoms of Achilles tendon rupture?
Symptoms of Achilles tendon rupture include the following:
- A pop or snap when the tendon tears
- Severe pain in back of the ankle, making it difficult to walk
- Swelling and discoloration
- Inability to rise on the toes
- A gap in the back of the ankle where the tendon ends separated after the tear.
Diagnosis and Tests
How is Achilles tendinitis diagnosed?
If you think you have Achilles tendinitis, make an appointment to see your doctor. The doctor will ask you about your recent activity and look for signs, such as:
- The foot not flexing when the calf muscle is pressed (if the Achilles ruptures)
- Swelling on the back of the heel
- Pain in the back of the heel
- Limited range of motion in the ankle
An ultrasound or MRI scan can check for tendinitis. If the tendon is enlarged, this can often be seen on radiographs (images).
How is an Achilles tendon rupture diagnosed?
The doctor will look at your foot, ankle, and leg. Often, the physical exam alone is enough to diagnose an Achilles tendon rupture. An ultrasound or a MRI may be used to determine the severity of the tear and the extent of separation of the fibers.
Management and Treatment
How is Achilles tendinitis treated?
Nonsurgical treatment is typically recommended first. Pain that lasts more than six months may require surgery.
Nonsurgical treatment methods include the following:
- Rest and stop doing activities that cause stress to the tendon.
- Apply ice to the tendon for 15 minutes after exercising.
- Compress the tendon by using an athletic wrap or surgical tape.
- Elevate the painful extremity. You can reduce swelling by lying down and raising your foot to a level that is above your heart.
- Stretch your ankles and calf muscles.
- Take anti-inflammatory medication (for example, ibuprofen) to reduce swelling.
- Wear heel lifts in good running shoes.
- Avoid barefoot walking or walking in shoes without a heel lift.
- Avoid walking up inclines, climbing ladders, and climbing stairs, if possible.
- Use a night splint.
- Take part in physical therapy.
- Depending on how severe the pain is, you can use a walking boot or walking cast.
How is an Achilles tendon rupture treated?
If you suspect you have an Achilles tendon rupture, you should see your doctor right away. There are surgical and non-surgical ways to treat the rupture. Surgery is the most common treatment.
The foot and ankle are flexed downward in a cast or boot. The cast or a boot will stay on anywhere from 8 to 12 weeks. Physical therapy will follow.
Surgery is recommended for those who are young to middle-aged and active. The ruptured tendon is sewn together during surgery. This is an outpatient procedure. Afterward, the leg is put into a splint cast or walking boot. Physical therapy will be recommended as the tendon heals.
Healing is nearly complete in about 4 to 6 months. However, it can take up to a year to return to sports fully.
How can you prevent Achilles tendinitis?
There are several things you can do to reduce the risk of Achilles tendinitis:
- Warm up every time before you exercise or play a sport.
- Switch up your exercises.
- Slowly increase the length and intensity of your workouts.
- Keep your muscles active and stay in shape all year-round.
When you see symptoms of Achilles tendinitis, stop whatever activity you are doing and rest.
How do you prevent an Achilles tendon rupture?
Prevention methods for Achilles tendinitis and Achilles tendon rupture are very similar:
- Stay in good shape.
- Stretch before exercising or playing sports.
- Strengthen calf muscles slowly.