Though the name seems strange, Achilles tendon injury or rupture is common among athletes who play recreational sports and other people. Simply put, an Achilles tendon injury affects the back side of the lower leg.
The Achilles tendon is a robust fibrous cord connecting the calf muscles to the heel bone. Overstretching this tendon can lead to a partial or complete tear (rupture).
When the Achilles tendon ruptures, you may hear a popping sound accompanied by a sharp, sudden pain in the back of the ankle and lower leg, which can significantly impact your ability to walk. While surgery is commonly used to repair such ruptures, nonsurgical treatments can often be just as effective for many individuals.
Key Points About Achilles Tendon Injuries
- The Achilles tendon can develop tendonitis, a condition where it becomes inflamed, swollen, and irritated.
- A tear or rupture of the Achilles tendon may occur, often accompanied by a popping sound from the back of the heel or calf. This requires immediate medical attention.
- Achilles tendon injuries can affect anyone and are commonly linked to repetitive stress on the tendon.
- Symptoms often include pain, stiffness, and swelling near the heel and the back of the leg.
- Treatment typically involves rest, anti-inflammatory medications, and targeted exercises. In severe cases, surgery may be required to repair the tendon.
- Preventing Achilles tendon injuries includes gradually increasing physical activity, wearing appropriate footwear, and avoiding uneven surfaces during exercise.
Symptoms of an Achilles Tendon Injury
Common symptoms of Achilles tendon injuries include:
- Pain along the back of the leg or near the heel.
- Increased pain during physical activity.
- Stiffness and soreness in the Achilles tendon, especially upon waking.
- Tenderness or discomfort in the tendon following exercise.
- Swelling and pain that worsens with activity throughout the day.
- Thickening of the tendon.
- Bone spurs near the heel.
- Difficulty flexing the injured foot.
- A popping sound followed by sudden, sharp pain may indicate a ruptured tendon.
Causes of Achilles Tendon Injuries
Achilles tendon injuries can result from several factors, including:
Tendonitis
Achilles tendonitis is often caused by overuse or damage to the tendon. It typically leads to pain along the back of the leg and around the heel. Over time, untreated tendonitis can cause parts of the tendon to thicken and harden. There are two main types of Achilles tendonitis:
- Noninsertional Achilles Tendonitis: This occurs when small tears develop in the middle fibers of the tendon, leading to pain, swelling, and gradual degeneration. It is more common in active, younger adults.
- Insertional Achilles Tendonitis: This type affects the point where the tendon attaches to the heel bone. It often leads to the formation of bone spurs (extra bone growth) and can occur in individuals of any age, even those who are not physically active.
Rupture
A rupture happens when the tendon fibres tear completely or partially. This can occur suddenly, often accompanied by a popping sound that seems to come from the back of the heel or calf. A rupture requires immediate medical attention to prevent further complications.
Who Is at Risk for Achilles Tendon Injuries?
Achilles tendon injuries can affect anyone, but they are often associated with repetitive stress on the tendon. Common risk factors include:
- A sudden increase in the amount or intensity of physical activity or sport.
- Starting a new sport or exercise routine.
- Tight calf muscles at the beginning of physical activity, can place extra strain on the tendon.
- Bone spurs on the heel may rub against the tendon and irritate.
- Wearing improper or unsupportive footwear during exercise.
- Exercising on uneven surfaces can lead to instability and added stress on the tendon.
- Use of fluoroquinolone antibiotics, which have been linked to an increased risk of tendon injuries.
How Is an Achilles Tendon Injury Diagnosed?
Pain along the back of the leg near the heel is a common symptom of an Achilles tendon injury. However, these injuries are sometimes mistaken for sprained ankles, making an accurate diagnosis crucial to ensure proper treatment. Various conditions can cause pain or impair the function of the Achilles tendon, so your healthcare provider will use several methods to confirm the diagnosis.
When evaluating an Achilles tendon injury, your healthcare provider will consider:
- Your Health and Medical History: A review of your overall health and any prior injuries or conditions affecting your legs or feet.
- Symptom Assessment: A detailed description of your symptoms, including when and how they began.
- Physical Examination: The provider will check your Achilles tendon for pain, swelling, and the presence of bone spurs.
- Range of Motion Test: An assessment of your ability to move your ankle and foot correctly to identify limitations or abnormalities.
Imaging Tests:
X-ray: Provides images of bones, helping detect bone spurs or calcification of the tendon.
MRI: Offers detailed views of the soft tissues, showing the extent of tendon damage and guiding treatment decisions.
Ultrasound: Real-time imaging of the tendon to assess its structure and detect any tears or inflammation.
Accurate diagnosis is essential to determine the severity of the injury and to choose the most effective treatment plan.
How Are Achilles Tendon Injuries Treated?
The treatment for an Achilles tendon injury depends on the severity of the damage. Options range from conservative methods to surgical intervention. Common treatments include:
Non-Surgical Treatments
- Rest: Reducing activity levels to allow the tendon to heal.
- Ice: Applying ice packs to reduce pain and swelling.
- Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen to relieve pain and inflammation.
- Strengthening Exercises: Specific exercises, particularly eccentric strength training, target the calf muscles to relieve pressure on the tendon.
- Physical Therapy: Focuses on improving mobility, flexibility, and strength.
- Low-Impact Activities: Exercises like swimming to maintain fitness without straining the tendon.
- Supportive Devices: Heel lifts, orthotic shoes, casts, splints, or walking boots to reduce strain on the Achilles tendon.
- Extracorporeal Shockwave Therapy: This treatment uses high-energy shockwave impulses to stimulate healing in damaged tendon tissue. While not commonly used, it may be recommended in certain cases to avoid surgery.
Surgical Treatments
If non-surgical options are ineffective, or the injury involves severe or complete tendon damage, surgery may be necessary. Surgical procedures vary depending on the extent and location of the injury:
- Calf Muscle Lengthening (Gastrocnemius Recession): Lengthens tight calf muscles to reduce stress on the Achilles tendon.
- Debridement and Repair: Removes damaged tendon tissue or bone spurs and repairs the remaining tendon.
- Tendon Transfer: Removes the damaged tendon tissue, strengthens the remaining tendon, and reinforces it by transferring another tendon to the heel bone.
Your healthcare provider will recommend the most appropriate treatment based on the injury's severity, location, and overall condition of the tendon.
What Are the Possible Complications of Achilles Tendon Injuries?
Achilles tendon injuries can lead to various complications, including:
- Persistent Pain: Ongoing pain, which may range from mild to severe.
- Mobility Issues: Difficulty walking or engaging in physical activities.
- Deformity: Changes in the shape of the tendon or heel bone, such as warping or thickening.
- Tendon Rupture: Reinjury can result in a complete or partial tendon rupture.
Complications may also arise from treatments for Achilles tendon injuries, such as:
- Cortisone Injections: While cortisone can reduce inflammation, it may weaken the tendon, increasing the risk of rupture.
- Surgical Risks: Surgery to repair the tendon can sometimes lead to pain, infection, or delayed healing.
Careful management of the injury and following your healthcare provider’s advice can help minimize these complications.
How Can I Prevent Achilles Tendon Injuries?
To help prevent Achilles tendon injuries, consider these important steps:
- Warm Up Properly: Always warm up before exercising, playing sports, or engaging in repetitive movements to prepare your muscles and tendons.
- Gradually Increase Activity: Slowly increase the intensity and duration of physical activity, rather than making sudden changes.
- Wear Proper Footwear: Choose shoes that provide the right support for the activity you’re doing.
- Avoid Uneven Surfaces: Refrain from exercising on uneven or unstable surfaces to reduce stress on the tendon.
- Listen to Your Body: Stop any activity that causes pain to prevent further strain on the Achilles tendon.
- Be Cautious with Medications: If you’re taking fluoroquinolone antibiotics, be aware of the increased risk of tendon injuries and exercise with caution.
How to Manage an Achilles Tendon Injury
- Follow your healthcare provider’s guidance to rest and address pain and swelling effectively.
- Opt for alternative ways to stay active, focusing on low-impact activities like swimming or cycling, which are gentler on your tendon compared to high-impact exercises like running.
- Inform your healthcare provider if these measures fail to alleviate pain, swelling, or functional limitations.
