Achilles Tendon Injuries

What is the Achilles tendon?

The Achilles tendon, or heel cord, is the largest tendon in the body. It is a large, ropelike band of fibrous tissue in the back of the ankle that connects the calf muscles to the calcaneous (heel bone). We rely on the Achilles tendon every time we move our foot and it is essential for walking, running and jumping. It also allows us to point our foot, stand on tiptoe and to push off for movement.

Types of Achilles tendon injuries:

• Bursitis. Bursa are tiny sacs of fluid throughout our body that lubricate movement where tendons (and skin) pass over bony prominences. Inflammation can occur in the bursa between the calcaneous and the Achilles tendon and is called bursitis.
• Tendonitis. Achilles tendonitis is inflammation of the Achilles tendon, usually just above the point where the tendon attaches to the heel bone.
• Tendonosis. A degeneration or breakdown of the substance of the tendon fibers can occur over time. This can predispose an individual to Achilles tendon tearing.
• Achilles tendon rupture. If you overstretch your Achilles tendon, it can tear or rupture. The tear can be partial or complete. Most commonly, the Achilles tendon ruptures during an activity which involves start-stop footwork or bursts of jumping, running and pivoting.

Causes of Achilles tendon injuries:

• Bursitis: irritation and pain in the back of the heel, which may be aggravated by wearing shoes.
• Tendonitis: pain when pushing off during walking and possible swelling.
• Achilles tendon rupture: immediate, sharp pain the back of the ankle and lower leg, preventing you from walking properly.
• Pop or snap sensation. There is an inability to rise on your toes of the affected leg.

Diagnosis:

Your physician will take a detailed history and conduct a thorough examination. The diagnosis of a complete tear can generally be made on clinical exam through a series of tests performed by your physician. If other studies are indicated, they can be conducted at the Imaging Center.

Treatment:

Bursitis and tendonitis can be treated by following the RICE protocol of:

• Rest the injured part.
• Ice the injury.
• Compress the injured area with an ace wrap or compression sleeve.
• Elevate the injured part.
• Over the counter non-steroidal medication such as Advil or Aleve may alleviate inflammation and therefore also decrease pain

Achilles tendon rupture requires surgery to suture the ends of the tendon back together. Your physician will make an incision in the back of the lower leg and then repair the tear. Following surgery, your physician will place you in a walking boot for several weeks. In order for the repair to heal and to avoid stretching of the repair, your physician will make adjustments to the boot at your post-op appointments, changing the position of your foot as healing occurs. He/she will then prescribe formal physical therapy for range of motion and strengthening. The objective of surgical treatment is to restore the normal length and tension to the tendon to allow you to return to the activities you enjoyed prior to the injury.

Prevention:

• Take the time to warm-up and cool-down before and after exercise/activity
• Alternate high impact with low impact exercise/sports such as swimming, biking
• Avoid activities that put consistent stress on your Achilles tendon, such as hill running and jumping activities
• Wear well fitting athletic shoes with cushioning in the heels
• Perform calf strengthening exercises. If you are unfamiliar with them, ask for instruction from your physician, an athletic trainer or personal trainer or a physical therapist