Injuries to the Achilles Tendon

Tendons are long, tough cords of tissue that connect muscle to bone. The Achilles tendon, the largest and strongest tendon in your body, connects the heel bone to the calf muscle at the back of the heel to enable activities such as walking, running and jumping. These activities cause a significant amount of stress on the tendon. An overly stressed Achilles tendon can be subject to mild or serious injuries. If the injury is mild or moderate, it may be limited to burning or stiffness. If the pain is severe, the Achilles tendon may be partly torn or even completely ruptured.

Causes

These injuries tend to happen when you start moving suddenly, more so when 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 he surges off the starting block. The abrupt action can be too much for the tendon to handle. Men over 30 are particularly prone to Achilles tendon injuries.

Certain situations can make you more likely to have this kind of 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 take medicines called glucocorticoids or antibiotics called fluoroquinolones.

Symptoms

Contact a doctor if you notice:

• 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 exercising
• Swelling with pain that gets worse as you’re active during the day
• Thickening of your tendon
• Bone spurs on the heel bone
• Difficulty flexing the affected foot
• A “pop” sound and sudden sharp pain, which can mean a ruptured tendon

Potential Treatments

Based on your doctor’s evaluation of the severity of your injury, treatments may include:

• Rest
• Ice
• Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief such as ibuprofen or naproxen
• Specific exercises to strengthen your calf muscles
• Physical therapy
• Eccentric strength training – exercises that help strengthen your calf muscles to take pressure off your tendon
• Low-impact activities, such as swimming
• Heel lifts in shoes, orthotic shoes, cast, splint, or a walking boot
• Extracorporeal shockwave therapy. This treatment uses high-energy shockwave impulses to help stimulate the healing process in damaged tendon tissue.

If these treatments do not work, or if the injury is severe, surgery may be recommended. The type of surgery depends on the location and amount of damage to your tendon.