Achilles Tendon Injuries

Your Achilles tendon is the largest and strongest tendon in your body. It’s a thick band of tissue in your lower leg that connects your calf muscle to your heel bone — you can feel it there, below your skin. It gives you the strength and flexibility you need to push off the ground, so you can walk, run, jump and climb stairs.

It’s always in use and it absorbs a lot of stress, so it’s easy to injure it through overuse or sudden impact, especially if you’re active and athletic. 

This part of your leg doesn’t have good blood flow, making Achilles tendon injuries common. They can range from mild inflammation to complete tears or ruptures. If you don’t treat them, they can get worse and the pain can be bad enough to make it hard for you to move.

If you think you’ve injured your Achilles tendon, get medical care right away so you don’t damage it more and you can recover as quickly as possible.

Causes and risk factors for Achilles tendon injuries

Risk factors that make these tendon injuries more likely include:

• Age: Your Achilles tendon is more likely to degenerate (break down) as you get older. It becomes less flexible and easier to injure.
• A sudden increase in activity: Quickly increasing how intensely you exercise can overstress the tendon, especially if you do a lot of running or jumping. 
• Starting a new sport: A new activity can stress your Achilles tendon.
• Overuse: Repeat stress can harm the tendon.
• Not warming up: When you don’t stretch properly before you exercise, you put extra strain on the tendon.
• Participating in certain sports: Injuries are more likely in sports where you quickly speed up, slow down or pivot, such as gymnastics, soccer, basketball, volleyball and tennis.
• Improper footwear: Wearing high heels or not wearing the right shoes for exercise or sports may cause issues.
• Exercising on an uneven surface: Working harder to gain your footing can strain the tendon.
• Foot and ankle problems: Structural issues like flat feet or high arches can increase tendon stress.
• Accidents: Falling or stepping into a hole could cause an injury.
• Bone spurs: These bone growths on your heel can rub against your Achilles tendon.
• Tight calf muscles: If your calf muscles aren’t very flexible, it can put added pressure on the Achilles tendon.
• Medical conditions: Diabetes, gout, lupus and rheumatoid arthritis can weaken this tendon.
• Certain medications: Glucocorticoids and fluoroquinolones antibiotics can make these injuries more likely.

Types of Achilles tendon injuries

Some common conditions include:

Achilles tendinitis

This inflammation of the tendon is often caused by overuse or increasing your physical activity. You may notice pain, swelling and warmth along the tendon, especially after you’ve been active. Your tendon might get thicker and harder.

There are two types of Achilles tendonitis:

• Noninsertional Achilles tendonitis: The fibers in the tendon tear and break down. It usually affects active young adults.
• Insertional Achilles tendonitis: The tendon is damaged where it meets the bone and bone spurs may form. It can happen at any age and in people who are active or inactive.

Achilles tendinosis

Achilles tendinosis is a chronic (long-lasting) condition that comes from long-term Achilles tendinitis, which causes cells in the tendon to break down. The repeated small tears in the tendon cause stiffness and pain over time, especially in the morning when you wake up or after you rest.

Achilles tendon rupture

This is a complete or partial tear of the tendon that’s usually caused by a sudden, forceful movement. You may feel a sharp pain, hear a pop sound, feel like you were kicked in the back of your heel and have trouble walking. You need medical care right away for a tendon rupture.

Symptoms of Achilles tendon injuries can limit your ability to move, making it painful or impossible to walk or perform simple activities.

Diagnosing Achilles tendon injuries: When to get help

If you have ongoing pain that doesn’t get better when you rest or you have trouble walking, you should see a health care provider as soon as possible to help keep the injury from getting worse.

Your provider will diagnose an Achilles tendon injury by:

• Asking you about your medical history and symptoms, including when they started and what you were doing, how severe they are and how they are impacting your life and activities.
• Performing a physical exam to check for tenderness, bone spurs, swelling and range of motion issues. 
• Order imaging tests like X-ray or MRI if needed to help confirm the diagnosis and see how severe the injury is. X-rays can show bone spurs and hardening of the tendon. MRI shows how much damage there is to the tendon, which can guide treatment decisions.

Treatment options for Achilles tendon injuries

Treating an Achilles tendon injury depends on how bad the injury is. For less severe injuries, your provider may recommend: 

• Anti-inflammatory drugs (NSAIDs): Over-the-counter (OTC) pain relievers like ibuprofen (Advil, Motrin) or naproxen (Aleve) may help reduce pain and swelling.
• Rest and ice: Reducing your activity and applying ice can help with swelling and discomfort.
• Compression: Wrapping the lower leg and ankle can help with swelling.
• Walking boot: A boot can immobilize your foot so your tendon can heal.
• Physical therapy: A physical therapist can help you exercise in ways that restore movement, strengthen your calf muscles and improve flexibility so you’re less likely to re-injure yourself.
• Strengthening exercises: Specific exercises can help gradually rebuild the strength in your tendon and calf and make future injuries less likely.

Recovery could take months, depending on how serious your injury is. You may need to try different forms of exercise while your tendon heals. Don’t push yourself, since you could reinjure the tendon and it could turn into a long-lasting problem.

Surgical treatment options

For major injuries, like a rupture of your Achilles tendon, or if you don’t get better with non-surgical treatment options, you may need surgery to reduce the risk of rerupture and restore your push-off strength: 

• Stitch the torn tendon ends back together (can be done using minimally invasive techniques)
• Lengthen your calf muscle
• Remove bone spurs and damaged parts of the Achilles tendon
• Strengthen the area by connecting another tendon to the heel bone to supplement of replace the function of your Achilles tendon if the damage to your tendon is severe

After you have surgery, rehab and physical therapy are important to help you regain your strength and mobility.

Preventing Achilles tendon injuries

Some injuries happen unexpectedly, but you can take steps to lower your risk of Achilles tendon injuries:

• Warm-up and stretch: Always stretch before physical activity, especially activities that include running or jumping.
• Choose low-impact activities: Swimming and bicycling are gentler on your Achilles tendon.
• Wear proper footwear: Supportive shoes can help reduce the stress on your Achilles tendon.
• Perform strengthening exercises: Strong calf muscles give your Achilles tendon more stability and support.
• Gradually increase your activity: Avoid sudden intense activity spikes since they can overstress the tendon.

Getting care for Achilles tendon injuries

Achilles tendonitis, tendinosis and ruptures can limit your activities and make it difficult or impossible for you to walk. Treatment options like rest, physical therapy and surgery can help you recover and regain your mobility.

At Banner Health, our team of orthopedic specialists can provide expert diagnosis and personalized treatment plans to get you back to your daily activities.