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Achilles Tendon Injuries

Your Achilles tendon is a fibrous band of tissue that links the muscles in your calf to your heel. Its strength and flexibility are important for jumping, running, and walking. Your Achilles tendon withstands a lot of stress and pressure during everyday activities, as well as during athletic and recreational play.

Occasionally, your health care provider will misdiagnose your tendon injury as a sprained ankle. It is important to get the right diagnosis so you can get the right treatment. Several common injuries can make your Achilles tendon painful or prevent it from working well.

Tendinitis

Your Achilles tendon can become inflamed — swollen and irritated. This may happen because of overuse or damage to the area. Tendinitis can cause pain down the back of your leg and around your heel. You might notice that parts of your tendon are getting thicker, and hardening, because of tendinitis. This is a degenerative condition, which means it will get worse if you don't treat it.

  • Noninsertional Achilles tendinitis. Small tears in the middle fibers of your tendon start to break it down. This causes pain and swelling. This type of tendinitis usually affects active, younger adults

  • Insertional Achilles tendinitis. This occurs in the spot where your tendon meets your heel bone, if the fibers in your tendon tear. Bone spurs also can grow out of the heel bone tissue, causing pain

Rupture

It is possible for the tears in your tendon fibers to break your tendon completely or partially. You might hear a “pop” that seems to come from the back of your heel or calf. A rupture needs immediate medical attention.

Symptoms

Symptoms of tendon injuries include:

  • Thickening of your tendon

  • Pain down the back of your leg or near your heel

  • Pain that gets worse when you're active

  • A stiff, sore Achilles tendon when you first get up

  • Pain in the tendon the day after a workout

  • Swelling with pain that gets worse as you're active during the day

  • Bone spurs on the heel bone

  • Difficulty flexing the affected foot

  • A “pop” sound accompanied by sudden sharp pain, which suggests a ruptured tendon

Who’s at risk

Anyone can develop tendinitis. The most common risk factors are:

  • Increased activity or a new sport

  • Tight calves, which can place more stress on your tendon

  • Bone spurs on your heel, which can aggravate your tendon

  • The wrong shoes or on uneven surface when you exercise

  • Treatment with fluoroquinolone, an antibiotic medication

Diagnosis

To diagnose your condition, your physician will consider:

  • Your overall health and medical history

  • A description of your symptoms

  • A physical examination of your Achilles tendon. This checks for bone spurs, pain, and swelling

  • A test of your ankle's range of motion

  • Imaging tests, such as X-ray or magnetic resonance imaging (MRI). Your doctor will use MRI most often to determine the extent of your tendon damage.

Treatment

Treatment depends on how badly injured your tendon is. It may include:

  • Rest

  • Low-impact exercise alternatives, such as swimming

  • Ice

  • Nonsteroidal anti-inflammatory drugs for pain relief

  • Specific exercises to strengthen your calf muscles

  • Physical therapy

  • Eccentric strength training. This is a system of exercises that help strengthen your calf muscles to take pressure off your tendon

  • Cortisone injections

  • Heel lifts in shoes

  • A walking boot

  • Extracorporeal shockwave therapy. This is a controversial treatment your doctor may recommend to see whether you can improve without surgery

  • Surgery to lengthen your calf muscles

  • Debridement surgery to remove damaged tendon tissue or bone spurs

  • Surgery to remove your damaged tendon tissue. The type of surgery depends on the amount of damage to your tissue and other factors, such as the severity of the tendinitis.

Complications

Complications of an Achilles tendon injury may include:

  • Pain, which can be severe

  • Difficulty walking or being active

  • Deformation of your tendon area or heel bone

  • Infection

  • Need for surgery

  • Tendon rupture from the injury. Occasionally, cortisone injections also can cause your tendon to tear.

Prevention

You can prevent injury to your Achilles tendon by:

  • Increasing activity gradually, rather than all at once

  • Wearing the correct shoes for your activities

  • Not exercising on uneven surfaces

  • Being aware of the risks of fluoroquinolone and exercising with caution if you’re taking this drug

When to call the doctor

Call your doctor immediately if you experience a “pop” sound and acute pain from the back of your leg or heel. Otherwise, schedule an appointment if pain or difficulty moving interferes with your regular daily activities.

How to manage or live with the condition

Follow your doctor’s recommendations to get rest and manage pain and swelling. Choose alternative ways to be active. Try low-impact activities that do not place a lot of stress on your tendon, such as swimming or bicycling, rather than a high-impact exercise like running. Always let your doctor know if these strategies don’t help reduce pain, swelling, and loss of function.

 

Online Medical Reviewer: Bass, Pat F., III, MD, MPH
Online Medical Reviewer: Fraser, Marianne, MSN, RN
Date Last Reviewed: 1/2/2013
© 2000-2014 The StayWell Company, LLC. 780 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.
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