Achilles Tendon Injuries
What Is an Achilles Tendon Injury?
The Achilles tendon is a strong, fibrous band that connects the calf muscle to the heel bone. Problems affecting the Achilles tendon are common among active middle-aged people and can cause pain at the back of the calf. In severe cases, these problems may result in a rupture of the Achilles tendon.
The Achilles tendon connects two major calf muscles—the underlying soleus and the thick outer gastrocnemius—to the heel bone. During contraction, these muscles pull on the Achilles tendon, causing your foot to point down and helping you rise on your toes. This powerful muscle group is essential for sprinting, jumping, and climbing.
Several conditions can affect the Achilles tendon, ranging from minor inflammation to severe rupture. Tendocalcaneal bursitis occurs when the fluid-filled sac (bursa) behind the heel bone becomes inflamed, often due to repeated overuse or ill-fitting shoes. Achilles tendonitis results from strain or chronic overuse, leading to inflammation, degeneration, and thickening of the tendon. In the most severe cases, excessive force during activities like sprinting or jumping can cause the tendon to rupture completely, particularly in weekend athletes or individuals with preexisting tendon weakness.
Common symptoms include pain and irritation at the back of the heel or just above it, noticeable thickening of the tendon, swelling, redness, and difficulty with walking or rising on the toes. An Achilles tendon rupture is often accompanied by an unmistakable snapping sound and a sensation similar to being kicked in the calf, followed by significant swelling and inability to rise on the toes.
Nonsurgical Treatments
Many Achilles tendon conditions can be effectively managed without surgery. Our doctors offer a range of nonsurgical treatments to help relieve pain, improve mobility, and protect long-term tendon health.
Lifestyle Modifications
Rest is crucial for Achilles tendon injuries. Limiting activities like walking on the affected leg and avoiding high-impact movements allows the tendon to heal. Small heel lifts (approximately one-quarter inch) can be placed in both shoes to minimize stress by putting slack in the calf muscle and Achilles tendon while maintaining proper alignment.
Medications & Injections
Anti-inflammatory medications such as aspirin or ibuprofen can help reduce pain and swelling. However, cortisone injections are not advised for tendocalcaneal bursitis and Achilles tendonitis due to an increased risk of tendon rupture following such injections.
Physical & Occupational Therapy
Physical therapy treatments for Achilles conditions often include ice therapy to reduce swelling and pain. Initially, ice should be applied for 15 minutes every hour. Cold temperature whirlpool treatments may also be recommended, as the cold water reduces swelling while the moving water provides a massage action. Supervised physical therapy may continue with ice bags, cold packs, or ice massages to support healing.
Supportive & Assistive Devices
For Achilles tendon ruptures treated conservatively, casting allows the vast majority of ruptures to heal. However, patients should be aware that cast treatment carries an increased risk of re-rupture compared to surgical repair, and the healed tendon may have significantly reduced strength.
Surgical Treatments
When nonsurgical options are no longer effective, surgery may offer lasting pain relief and improved function. The right surgical approach depends on your age, activity level, tendon condition, and how far the condition has progressed.
Achilles Tendon Debulking
For persistent tendonitis and tendinosis, a procedure called debulking of the Achilles tendon may be performed. This surgery is done through an incision on the back of the ankle near the Achilles tendon. The surgeon removes any inflamed tissue covering the tendon (paratenon), then splits the tendon to remove the degenerative portion. The split tendon is then repaired and allowed to heal. Removing the degenerative portion stimulates repair of the tendon to a more normal, healthy state.
Achilles Tendon Rupture Repair
Surgery is often recommended for ruptured Achilles tendons, particularly for active individuals. The procedure involves reattaching the two ends of the torn tendon through an incision on the back of the ankle. Various techniques have been developed to repair the tendon, most involving sewing the two ends together. Minimally invasive repair techniques are available to reduce incision size. Following surgery, a cast or brace protects the repair for six to eight weeks, after which a high-heeled shoe may be worn for several weeks. Physical therapy is recommended to regain full ankle motion and calf muscle strength.