Achilles Tendonitis and Achilles Rupture

The Achilles tendon, the largest tendon in the body, is located in the back of the lower leg and connects the calf muscles to the heel bone. When the muscles contract, they pull on the Achilles tendon, causing the foot to point down. This is what makes a person able to stand on the toes or push off while walking or running.

The Achilles tendon is prone to overuse injuries. Achilles tendonitis occurs when the tendon and tissues around the tendon become irritated and inflamed, causing pain and possibly weakness. In more advanced cases of Achilles tendonitis, very small micro tears may occur in the tissue and tendon.

If not taken care of properly, tendonitis continues to weaken the tendon to the point where a person may suffer a partial tear or a full tear, which is called an Achilles tendon rupture.

ACHILLES TENDONITIS

What causes Achilles tendonitis?

Achilles tendonitis is most often caused by overuse or repeated movements during sports, work or other activities. It can be caused by a single incident of overstressing the tendon, or it can come on gradually after a series of stresses.

Athletes, both well conditioned and poorly conditioned, can develop the condition. The tendonitis usually develops following sudden changes in activity level, training on poor surfaces or wearing inappropriate footwear. For example, runners are likely to experience Achilles problems when they significantly increase their distance mileage or hill training. Basketball players who do a lot of jumping also are prone to Achilles tendonitis. People who exercise infrequently or are just starting an exercise program are more likely to develop the condition because inactive muscles and tendons have little flexibility.

Additional contributing factors may include the following:

• Age: The tendon tends to weaken and blood supply is lessened as someone gets older, so the tendon is easier to damage and takes longer to heal.
• Weight: The heavier a person is, the more the stress on the Achilles tendon.
• Trauma: A direct blow to the tendon can result in tendonitis.
• Congenital: Some conditions present at birth cause a person to have a slightly abnormal rotation of the foot and leg when they walk (pronation problems), causing more stress on the Achilles tendon.
• High heel shoes: Frequently wearing high heels causes the lower calf muscles and the Achilles tendon to shorten over time because the heel is not stretched to the ground. When the person switches to athletic shoes for exercise or flat-heeled shoes for the weekend, the Achilles tendon stretches more than it is used to and may become inflamed

What are the symptoms of Achilles tendonitis?

In most cases, the symptoms of Achilles tendonitis develop gradually. The symptoms include the following:

• Pain in the back of the heel where the tendon meets the heel bone and maybe in the lower part of the calf muscle.
• Pain that is especially noticeable after a period of inactivity, such as first thing in the morning or after sitting at a desk for a long period of time.
• Stiffness that sometimes goes away as the tendon warms up.
• Swelling over the Achilles tendon area.
• Decreased strength or range of movement in the tendon area.

How is Achilles tendonitis treated?

Most doctors prefer conservative, non-surgical treatment to try to stop the progression of Achilles tendonitis. Depending upon the severity of the tendonitis, treatment may include the following options:

• Rest: The tendon needs time to heal, so a person should stop doing exercise or activities that stress the Achilles tendon or switch to another form of exercise, such as swimming, that does not stress the tendon.
• Anti-inflammatory medications: These will help with the pain and reduce swelling and inflammation.
• Physical therapy: Exercises to strengthen the calf muscles and stretches to lengthen the tendon and muscles are often prescribed.
• Immobilization: Wearing a special brace or boot limits ankle motion and stretches the Achilles tendon to allow healing.
• Shoes: Wearing properly supportive shoes for athletic activities will help prevent Achilles tendonitis.
• Orthotics or heel cushion lifts: Special inserts for shoes will help relieve stress on the heel and tendon, and will support the foot’s arch.

ACHILLES TENDONITIS

What causes an Achilles tendon rupture?

A rupture of the Achilles tendon is most often caused by a sudden, forceful motion that stresses the calf muscle. This usually occurs during physical activity that requires sudden moves, such as basketball, tennis and soccer. It can also happen from something like just trying to jump over a puddle.

Other factors contributing to a rupture may include a weakened tendon. The small tears and long-term inflammation of Achilles tendonitis can cause the tendon to become weak and more prone to rupture.

What are the symptoms of an Achilles rupture?

A small Achilles tear may have no or very mild symptoms. The symptoms are similar to those of Achilles tendonitis and include:

• Pain in the back of the heel where the tendon meets the heel bone and/or in the lower part of the calf muscle.
• Pain that is especially noticeable after a period of inactivity, such as first thing in the morning or after sitting at a desk for a long period of time.
• Stiffness that sometimes goes away as the tendon warms up.
• Swelling over the Achilles tendon area.
• Decreased strength or range of movement in the tendon area.

If the Achilles tendon ruptures, the symptoms are more obvious. The symptoms include:

• Intense, sharp pain.
• A sharp snapping or popping sound.
• Heavy swelling and possible bruising.
• An inability to point the foot down or stand on the toes.
• Painful walking.

How is an Achilles rupture treated?

A completely torn Achilles tendon normally requires surgery soon after the rupture. An orthopaedic surgeon will reattach the ends of the torn tendon to their normal position. The surgery involves making an incision along the back of the ankle.

After surgery, a patient is required to wear a cast for at least six to eight weeks. An intensive physical therapy rehabilitation program is also required to strengthen the supporting muscles, increase flexibility and heal the tendon.