Achilles Tendon Injuries

What Is an Achilles Tendon Injury?

An Achilles tendon injury can happen to anyone, whether you’re an athlete or just going about your everyday life.

The Achilles tendon is the largest tendon in your body. It stretches from the bones of your heel to your calf muscles. You can feel it: a springy band of tissue at the back of your ankle and above your heel. It lets you point your toes toward the floor and raise up on your tiptoes.

It’s common for this tendon to get injured. It can be mild or moderate and feel like a burning pain or stiffness in that part of your leg. If the pain is severe, your Achilles tendon may be partly or completely torn.

Achilles tendinitis is another type of injury in which some part of your tendon is inflamed. There are two main types of this condition, which affect different parts of your tendon:

• Noninsertional Achilles tendinitis. Fibers in the middle of your tendon break down, swell, and get thick.
• Insertional Achilles tendinitis. This affects the lower part of your heel, where your tendon inserts, or goes into, your heel bone. It can cause bone spurs.

Achilles Tendon Injury Symptoms

The most obvious sign is pain above your heel, especially when you stretch your ankle or stand on your toes. It may be mild and get better or worse over time. If the tendon ruptures, the pain is instant and severe. The area may also feel tender, swollen, and stiff. If your Achilles tendon tears, you may hear a snapping or popping noise when it happens. You could have bruising and swelling, too. You also may have trouble pointing your toes and pushing off your toes when you take a step.

Achilles Tendon Injury Causes

Achilles tendon injuries are common in people who do things where they quickly speed up, slow down, or pivot, such as:

• Running
• Gymnastics
• Dance
• Football
• Soccer
• Baseball
• Softball
• Basketball
• Tennis
• Volleyball

These injuries tend to happen when you start moving suddenly as you push off and lift your foot rather than when you land. For instance, a sprinter might get one at the start of a race as they surge off the starting block. The abrupt action can be too much for the tendon to handle. Men over 30 are especially prone to Achilles tendon injuries.

You can also injure your Achilles tendon if you stress it over and over with high-impact activities. These are known as repetitive stress injuries.

You don’t have to be an athlete to get this kind of injury. If you step into a hole or fall from a high place, you could rupture your Achilles.

Achilles Tendon Injury Risks

These things may make you more likely to get an Achilles tendon injury:

• You wear high heels, which can stress the tendon.
• You have "flat feet," also called fallen arches. This means that when you take a step, the impact causes the arch of your foot to collapse, stretching the muscles and tendons.
• Your leg muscles or tendons are too tight.
• You have bone spurs.
• You add time to your exercise routine or do more intense activity.
• You start a new type of exercise.
• You wear shoes that don’t fit well or aren’t right for the kind of physical activity you do.
• You work out on uneven surfaces.
• You take medicines called glucocorticoids or antibiotics called fluoroquinolones.
• You have a chronic condition that can weaken your Achilles, like rheumatoid arthritis, lupus, gout, or diabetes.

Achilles Tendon Injury Diagnosis

Doctors sometimes mistake an Achilles tendon injury for sprained ankle. To make the right diagnosis, your doctor will start with a physical exam. They may want to see you walk or run so they can look for problems that might have led to your injury.

They also might do something called the calf squeeze test. You'll kneel on a chair or bench or lie on your stomach on the exam table. Your doctor will gently squeeze the calf muscle on your healthy leg. This will pull on the tendon and make your foot move. Next, they’ll do the same thing on your other leg. If your Achilles tendon is torn, your foot won't move, because your calf muscle won't be connected to your foot.

Your doctor may test your range of motion to see if you can move your ankle the way you should. They may also do imaging tests, such as X-ray or MRI. These tests can show what kind of tendon damage you have and help them decide on the best treatment for you.

Achilles Tendon Injury Treatment

Minor to moderate Achilles tendon injuries should heal on their own. To speed the process, you can:

• Rest your leg. Avoid putting weight on it as best you can. You may need crutches.
• Ice it. Ice your injury for up to 20 minutes at a time as needed.
• Compress your leg. Use an elastic bandage around the lower leg and ankle to keep down swelling.
• Raise (elevate) your leg. Prop it on a pillow when you're sitting or lying down.
• Take anti-inflammatory painkillers. Nonsteroidal anti- inflammatory drugs (NSAIDs) like ibuprofen and naproxen can help with pain and swelling. Follow the instructions on the label to help prevent side effects, such as bleeding and ulcers. Take them with food. Check with your doctor first if you have any allergies, have medical problems, or take any other medication. If you need them for longer than 7 to 10 days, call your doctor.
• Use a heel lift. Your doctor may recommend that you wear an insert in your shoe while you recover. It will help protect your Achilles tendon from further stretching.
• Practice stretching and strengthening exercises as recommended by your doctor, physical therapist, or other health care provider.

Achilles Tendon Surgery

If your Achilles is torn, your doctor may recommend surgery. The younger and more active you are, the more likely that surgery will be the best option.

You should have the surgery within 4 weeks of the injury. Your surgeon will make a small incision in the back of your ankle and sew the Achilles back together. Sometimes they’ll need to sew other tendons in to make things even stronger. Between 80% and 90% of these operations are successful.

Your doctor could decide not to do surgery if you’re older and less active, or if you have only a partial tear.

The nonsurgical route will involve lots of physical therapy and doing stretches and exercises on your own. You might also have ultrasound or shockwave therapy. You may have to wear a cast, a walking boot, or heel cups to take pressure off the tendon and keep it from moving.

You’ll have a longer road to full recovery, and you’ll run a bigger risk of reinjuring the tendon.

Achilles Tendon Injury Recovery

Recovery may take months, but it depends on how serious your injury is. Different conditions heal at different rates.

You can still be active while your injury heals. Ask your doctor what’s OK to do. But don't rush things. Don't try to return to your old level of physical activity until:

• You can move your leg as easily and freely as your uninjured leg.
• Your leg feels as strong as your uninjured leg.
• You don't have any pain in your leg when you walk, jog, sprint, or jump.

If you push yourself too much before your Achilles tendon injury fully heals, you could get injured again, and the pain could become a long-lasting problem. You may be able to avoid some of these issues if you replace high-impact sports like running with low-impact exercise. Activities such as swimming or cycling put less stress on your tendon.

Achilles Tendon Injury Prevention

Here are some things you can try:

• Stretch and strengthen your calves.
• Cut down on uphill running.
• Wear shoes with good support that fit well.
• Stop exercising if you feel pain or tightness in the back of your calf or heel.

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