Achilles Tendon Injury

What is an Achilles tendon injury?

The Achilles tendon is a band of tissue that connects the heel bone to the calf muscle of the leg. Injury to the tendon may cause it to become inflamed or torn.

Achilles tendinopathy is an injury to your Achilles tendon from overuse. The term tendinopathy includes tendonitis and tendinosis. Achilles tendonitis is the term used when the tendon is inflamed. Tendinosis refers to tiny tears in the tendon. They both cause pain at the back of your leg by the heal.

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?

• Put ice packs on the Achilles tendon for 20 to 30 minutes every 3 to 4 hours for the first 2 or 3 days or until the pain goes away.
• Raise your lower leg on a pillow when you are lying down.
• Take anti-inflammatory medicine as prescribed by your healthcare provider. Adults aged 65 years and older should not take non-steroidal anti-inflammatory medicine for more than 7 days without their healthcare provider's approval.
• 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.
• 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.
• Do any exercises your healthcare provider gives you to stretch and strengthen your Achilles tendon.
• 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.
• 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 will be determined by 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, avoid running uphill a lot.