Achilles Tendonitis/tear
What is Achilles Tendonitis/Tear?
Achilles tendonitis is inflammation of the tendon connecting the calf muscles to the heel bone. A tear (partial or complete) can occur due to excessive stress or trauma.
- Common in runners and middle-aged athletes
- Leads to pain at the back of the heel or calf
- Can be acute (sudden) or chronic (gradual onset)
- May present as tendinitis (inflammation) or tendinosis (degeneration)
Overview of the Condition
Repetitive strain, abrupt increases in activity, or insufficient stretching can injure the Achilles tendon. Severe force can cause a rupture, often felt as a pop with immediate difficulty walking. Chronic cases may develop over time, leading to thickening and pain. Treatment varies based on severity, from conservative management to surgical intervention.
Symptoms
- Pain and stiffness in the Achilles tendon, especially in the morning
- Thickening of the tendon, tenderness to touch
- Sudden sharp pain and a 'pop' feeling if rupture occurs
- Swelling and bruising around the tendon
- Difficulty walking or climbing stairs
- Weakness in the calf muscle
- Limited range of motion in the ankle
- Pain that worsens with activity and improves with rest
- Crepitus (grating sensation) when moving the tendon
- Increased pain with prolonged standing or walking
- Pain that radiates up the calf or down to the heel
Causes
- Overuse from repetitive activities (running, jumping)
- Sudden increase in physical activity or intensity
- Poor footwear or lack of proper support
- Tight calf muscles or Achilles tendon
- Age-related degeneration of the tendon
- Previous history of Achilles injuries
- Inadequate warm-up before exercise
- Certain medications (e.g., fluoroquinolones) that may weaken tendons
Diagnosis
- Physical examination to assess tenderness, swelling, and range of motion
- Thompson test to check for rupture (squeezing calf muscle)
- Ultrasound or MRI for imaging to confirm diagnosis and assess severity
- X-rays to rule out bone-related issues or calcifications
- Assessment of gait and biomechanics to identify contributing factors
Treatment Options
- RICE protocol and activity modification
- Physical therapy with eccentric calf exercises
- Heel lifts or orthotics to reduce stress
- Surgery for complete tears or severe cases
Conservative Management
Mild or partial tears often improve with rest, immobilization (boot), and a structured rehab program focusing on gradual loading of the tendon.
Rehabilitation Exercises
- Eccentric calf lowers on a step
- Plantarflexion/dorsiflexion with resistance bands
- Progressive weight-bearing and balance exercises
- Stretching of the calf and Achilles tendon
- Gradual return to sport-specific activities
When is Surgery Needed?
Complete ruptures or significant partial tears in active individuals often undergo surgical repair to restore tendon continuity and strength.
Surgical Procedures
- Primary end-to-end tendon repair
- Tendon graft augmentation if tissue quality is poor
- Protective boot or cast post-op, followed by rehab
Anatomy Overview
The Achilles is the largest tendon, connecting the gastrocnemius and soleus muscles to the calcaneus. It endures high loads during walking and running.
Affected Areas
- Mid-tendon area (common for tendinitis)
- Insertional area near the heel bone
- Surrounding paratenon, which can become inflamed
Frequently Asked Questions
| Question | Answer |
|---|---|
| How long is recovery after an Achilles rupture? | Typically 4-6 months for basic functional recovery, though return to high-level sports can take up to a year. |
| Can I prevent Achilles tendon injuries? | Proper warm-up, calf stretching, gradual training increases, and supportive footwear can reduce risk. |
| What are the signs of a ruptured Achilles tendon? | A sudden sharp pain, swelling, bruising, and difficulty walking or standing on tiptoes. |
| Is surgery always necessary for Achilles tendonitis? | No, many cases respond well to conservative treatment. Surgery is reserved for severe or chronic cases. |
| Can I run with Achilles tendonitis? | Running may exacerbate symptoms. It's best to modify activity and consult a healthcare provider. |
| What is the difference between tendinitis and tendinosis? | Tendinitis refers to inflammation of the tendon, while tendinosis indicates degeneration without inflammation. |
| Are there any specific exercises to avoid? | High-impact activities or excessive stretching of the calf should be avoided during acute phases. |
| How can I manage pain at home? | Rest, ice application, over-the-counter pain relievers, and gentle stretching can help manage symptoms. |
| What footwear is best for Achilles tendonitis? | Shoes with good arch support, cushioning, and a slight heel lift can help alleviate strain on the tendon. |
| When should I see a doctor? | If pain persists despite home care, or if you experience severe swelling, bruising, or difficulty walking. |
Prevention Strategies
- Gradual progression in running or sports
- Regular calf and Achilles stretches
- Avoid sudden increases in training intensity