What Is an Achilles Tendon Injury?: Causes, Symptoms & Treatments

What Constitutes an Achilles Tendon Injury?

An Achilles tendon injury is a condition that can affect anyone, regardless of whether you’re an athlete or simply going about your daily routine.

The Achilles tendon, the body’s largest tendon, extends from the heel bones to the calf muscles. It is palpable as a resilient band of tissue located at the rear of the ankle, just above the heel. This tendon facilitates movements such as pointing the toes downward and rising onto the tiptoes. Due to its robust, densely packed fibers, the Achilles tendon possesses significant strength, capable of withstanding forces of up to 1,100 pounds.

However, the Achilles tendon is susceptible to injury because of limited blood circulation in the region. This injury is often referred to as tendinitis or tendonitis by medical professionals. Symptoms may include a sensation of burning or stiffness in the lower leg area. In cases of severe pain, the Achilles tendon may suffer partial or complete tears.

Symptoms of Achilles Tendon Injury

There are several common indicators that suggest you may have injured your Achilles tendon:

1. Tightness in the Achilles tendon upon waking in the morning
2. Stiffness or discomfort along the length of the Achilles tendon
3. Pain exacerbating with physical activity
4. Heel discomfort experienced while wearing shoes
5. Intense pain occurring the day following physical exertion
6. Thickening or swelling around the affected area
7. Presence of bone spurs (bony growths)
8. Persistent swelling or recurring swelling episodes
9. Direct pain localized in the Achilles tendon

The most evident indication of an Achilles tendon injury is experiencing pain above the heel, particularly when extending the ankle or rising onto tiptoes. This pain might be mild initially and fluctuate in intensity over time. However, if the Achilles tendon tears or ruptures, the onset of pain is sudden and can be severe. Seeking medical attention promptly is advisable in such cases.

Formation of a lump on the Achilles tendon

Following an injury to the Achilles tendon, it’s common to notice a lump in the affected area. Sometimes, this lump arises due to swelling, indicating a moderate degree of Achilles tendinitis. Alternatively, if the lump persists for an extended period, it may suggest ongoing healing processes within the region.

Types of Achilles Tendon Injuries

Achilles tendon injuries come in various forms, primarily categorized into two types of tendinitis:

1. Noninsertional Achilles tendinitis: This injury occurs when the fibers in the middle of the tendon deteriorate, causing swelling and thickening. It is more prevalent among highly active individuals, particularly runners.

2. Insertional Achilles tendinitis: This affects the lower segment of the heel where the tendon inserts or attaches to the heel bone. It tends to lead to the formation of bone spurs. While common among runners, it can affect individuals regardless of activity level, often attributed to tight calf muscles exerting additional strain on the Achilles tendon.

It’s possible to experience one or both types of tendinitis simultaneously.

Other Achilles tendon injuries comprise:

1. Achilles bursitis: Positioned at the rear of the heel, a fluid-filled sac known as a bursa cushions the Achilles tendon during movement. Overuse of the ankle or foot can inflame this bursa. Additionally, conditions like arthritis, gout, or wearing ill-fitting shoes can trigger irritation. Retrocalcaneal bursitis is another term for Achilles bursitis.

2. Achilles tendon rupture: A tearing of the Achilles tendon, either partially or completely detaching from the heel bone, often accompanied by a snapping or popping sound. This rupture differs from tendinitis, causing immediate and severe pain, along with bruising and swelling. Mobility may be impaired, with difficulty pointing toes or pushing off when walking.

Achilles tendinitis versus tendinosis:

While these terms may sound similar, they denote distinct conditions.

1. Achilles tendonitis or tendinitis signifies inflammation of the tendons, typically a transient issue.

2. Achilles tendinosis indicates prolonged or chronic tendinitis, where the tendon cells undergo degradation, potentially impacting the Achilles tendon’s functionality over time.

Causes of Achilles Tendon Injury

Injuries to the Achilles tendon often occur during activities involving sudden acceleration, deceleration, or changes in direction, such as:

1. Running
2. Gymnastics
3. Dancing
4. Football
5. Soccer
6. Baseball
7. Softball
8. Basketball
9. Tennis
10. Volleyball

These incidents typically arise during rapid movement initiation, where there’s a forceful push-off and foot elevation rather than during landing. For example, a sprinter may sustain an injury at the beginning of a race when launching from the starting block. Such sudden actions can exceed the tendon’s capacity to withstand strain.

Additionally, repetitive stress injuries can occur from subjecting the Achilles tendon to repeated high-impact activities.

However, one doesn’t necessarily need to be an athlete to experience this type of injury. Stepping into a depression or falling from a height can also lead to Achilles tendon rupture.

Factors that increase the likelihood of sustaining an Achilles tendon injury include:

1. Wearing high heels, which can place strain on the tendon.
2. Having “flat feet,” or fallen arches, causing the foot’s arch to collapse upon impact while walking, thereby stretching the muscles and tendons.
3. Experiencing tightness in leg muscles or tendons.
4. Developing bone spurs.
5. Increasing the duration or intensity of exercise.
6. Engaging in a new form of physical activity.
7. Wearing ill-fitting shoes or inappropriate footwear for the type of activity performed.
8. Exercising on uneven surfaces.
9. Taking medications such as glucocorticoids or fluoroquinolone antibiotics.
10. Suffering from chronic conditions like rheumatoid arthritis, lupus, gout, or diabetes, which can weaken the Achilles tendon.

Individuals at higher risk of a ruptured Achilles tendon include those who are:

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1. Assigned male at birth.
2. Aged between 30 and 40 years.
3. Participating in sports involving extensive running and jumping.
4. Receiving steroid injections in the ankle, potentially weakening the nearby Achilles tendon.
5. Carrying excess weight.

Diagnosis of Achilles Tendon Injury

Identifying an Achilles tendon injury can sometimes be confused with a sprained ankle by healthcare professionals. To accurately diagnose the condition, your doctor will initiate with a physical examination. Observing your gait or running pattern enables them to pinpoint potential issues leading to the injury.

Moreover, they may conduct a calf squeeze examination. During this procedure, you’ll be positioned kneeling on a chair or lying prone on the examination table. Your doctor will gently compress the calf muscle of your uninjured leg, causing movement in your foot. Subsequently, they repeat the process on the affected leg. If the Achilles tendon is torn, there will be limited foot movement as the calf muscle fails to engage with the foot.

Assessing your range of motion to evaluate ankle mobility is another aspect of the examination. Additionally, your doctor may recommend imaging tests like X-rays or MRIs to determine the extent of tendon damage and devise an appropriate treatment plan.

Treatment for Achilles Tendon Injury

For minor to moderate Achilles tendon injuries, typically they resolve on their own. To expedite recovery, consider the following steps:

1. Rest your leg: Minimize weight-bearing activities and consider using crutches if necessary.
2. Apply ice: Ice the affected area for up to 20 minutes as needed to reduce inflammation.
3. Compression: Wrap an elastic bandage around the lower leg and ankle to alleviate swelling.
4. Elevate your leg: Prop it up on a pillow when sitting or lying down to reduce swelling.
5. Take anti-inflammatory painkillers: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help manage pain and swelling. Follow dosage instructions carefully and consult your doctor, especially if you have allergies or existing medical conditions.
6. Utilize a heel lift: Consider using an insert in your shoe as recommended by your doctor to protect the Achilles tendon from further strain.
7. Engage in stretching and strengthening exercises: Consult with your doctor or a physical therapist for appropriate exercises.
8. Participate in low-impact activities: Once approved by your doctor, activities such as swimming can aid in the healing process.

Achilles Tendinitis Brace

In the case of a mild sprain, your doctor may demonstrate how to tape your Achilles tendon or suggest using kinesiology tape to relieve pressure during activity. For severe injuries, immobilization may be necessary through a walking boot, splint, or cast. Alternatively, a night splint may be recommended to maintain stretch during sleep.

Signs to Seek Immediate Care

While an Achilles tendon injury typically isn’t considered an emergency, certain symptoms warrant prompt medical attention. These include:

1. Hearing a “pop” or “snap” at the time of injury.
2. Inability to bear weight on the foot or ankle.
3. Persistent pain disrupting sleep.
4. Swelling in the leg.
5. Change in color or temperature of the foot or ankle.
6. Signs of infection, such as fever or fatigue.

Achilles Tendon Surgery

In cases of Achilles tendon rupture, surgical intervention may be advised by your physician, especially for younger and more physically active individuals, as it often presents the most effective option.

Ideally, surgery should be performed within four weeks of the injury. During the procedure, a small incision is made at the rear of the ankle, and the Achilles tendon is meticulously reattached. In some instances, additional tendons may be incorporated to bolster its strength. Success rates for these surgeries typically range between 80% and 90%.

For older individuals or those with partial tears, surgery may not be deemed necessary by the medical team.

Alternatively, a nonsurgical approach may be recommended, involving extensive physical therapy, independent stretching and exercise regimens, and possibly adjunct therapies such as ultrasound or shockwave therapy. Additionally, supportive measures like wearing a cast, a walking boot, or heel cups may be prescribed to alleviate pressure on the tendon and restrict its movement.

While opting for the nonsurgical route may offer a viable path, it often entails a longer recovery period and an increased risk of tendon re-injury.

Recovery from an Achilles tendon injury can span several months, contingent upon its severity as different conditions undergo varied rates of healing.

During the healing process, it’s possible to remain physically active, but it’s crucial to consult your doctor regarding permissible activities. However, it’s important not to hasten the recovery process. It’s advisable to wait until:

– Your leg can move with the same ease and range of motion as your uninjured leg.
– Your leg exhibits the same level of strength as your uninjured leg.
– You experience no discomfort in your leg while engaging in activities such as walking, jogging, sprinting, or jumping.

Exercising excessively before full recovery from an Achilles tendon injury may lead to reinjury and chronic pain. To mitigate such risks, consider replacing high-impact sports like running with low-impact exercises such as swimming or cycling, which impose less strain on your tendon.

Here are some tips for safeguarding your Achilles tendons:

1. Engage in calf stretching and strengthening exercises.
2. Prioritize warming up before and cooling down after workouts.
3. Steer clear of exercising, especially running, on uneven terrain.
4. Gradually escalate the duration or intensity of your workouts.
5. Opt for properly fitting shoes with adequate support.
6. Cease exercising immediately if you experience any discomfort or tightness in the rear portion of your calf or heel.

Strengthening your calf muscles can alleviate strain on your Achilles tendon. These stretches are easily performed at home, but it’s advisable to consult your doctor to ensure they’re suitable for you.

Calf Stretch: Stand facing a wall, about an arm’s length away. Keep one leg straight with the heel on the ground. Bring the other leg closer to the wall, bending the knee and gently pressing the hips towards the wall. You should feel a stretch in the back of the straightened leg. Hold for 10 seconds, then switch sides. Repeat up to 20 times per leg.

Calf Raise: Sit in a chair with your feet flat on the ground. Attempt to raise your heels while keeping the balls of your feet on the floor. Hold for 30 seconds and repeat 5 times.

Lower Calf Strengthener: Stand in front of a counter with slightly bent knees. Holding onto the counter for support, slowly rise onto your toes, then lower back down. Aim for 30 repetitions.

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