Achilles Tendon Problems: What You Need to Know
Stephen F. Conti, MD
Achilles tendon problems are very common, especially among middle-aged “weekend warriors” who don’t exercise regularly. The largest and strongest tendon in the body, the Achilles anchors the calf muscles to the heel bone — which subjects it to very high forces. When running, the Achilles tendon can pull with a force equal to many times the body weight. And, because it lacks a strong blood supply, the tendon can weaken and degrade over time, putting it at risk of a rupture.
Achilles tendon injuries may seem to happen suddenly, but they usually result from tiny tears that happen over time. These chronic, or long-term injuries, to the tendon microstructure often result from overuse or training. In some cases, the tendon damage goes undetected until a large force, such as a cut or jump, causes it to rupture — often with an audible "pop." Many patients feel as if they were shot or kicked in the back of the ankle.
Types of Achilles Tendon Injuries
- Achilles tendonitis is an inflamed or painful tendon
- Achilles tendinosis, or tendinopathy, are tiny tears (microtears) and internal degeneration of the tendon causing soreness or stiffness. It comes on gradually and continues to worsen until treated
- Achilles tendon rupture is tearing and separation of the tendon fibers so that the tendon can no longer function normally
Common causes of Achilles tendon injuries include:
- Sudden increase in the amount or intensity of physical activity
- Wearing high heels
- High arched or flat feet
- Tight muscles or tendons in the leg
Early treatment works best and can prevent additional injury. Minor Achilles tendon discomfort can be treated with rest, anti-inflammatory medication, stretching, and moist heat. An orthopaedic foot and ankle specialist should treat any Achilles tendon discomfort lasting longer than a month.
Newer specialized treatments include Platelet Rich Plasma (PRP) injection therapy. Physical therapy also can be helpful.
Treatment for severe problems, such as a torn or ruptured tendon, may include surgery, or a cast, splint, brace, walking boot, or other device that immobilizes the lower leg. Surgery includes removing a bone spur that is hitting the Achilles tendon, repairing the tear, and removing the damaged portion and transferring the tendon to the heel bone to restore motion.
Patients who undergo surgery can expect to be on crutches and in a cast for six to eight weeks, followed by months of therapy. It may take up to a year to reach maximum improvement. Although it takes time, the treatment of Achilles tendon problems usually works with most people returning to sports and other activities.