If you are a competitive or recreational athlete, chances are you have either personal or second hand experience with Achilles tendon injuries. Although only the full ruptures in professional athletes tend to dominate the news, injuries Achilles tendon are one of the most common everyday issues involving the foot and ankle.
The best way to know if you’re dealing with an Achilles tendon injury, or even to prevent it, is to be informed. Learn more about this part of the body and how the injury can affect you.
What is the Achilles tendon?
The Achilles tendon is the largest tendon in the human body. It is the tendon that connects the calf muscles to the heel bone. When the calf muscles activate, the tendon shortens and pulls up on the back of the heel bone, resulting in plantar flexion of the foot and the “push off” phase of gait. Injuries or dysfunction involving the Achilles tendon can therefore compromise not only high impact sports such as basketball and running, but also low impact activities like walking (particularly downhill) and golf.
What do Achilles tendon injuries feel like?
Symptoms involving the Achilles tendon can be acute or chronic. Acute symptoms usually occur when there is an injury. The most serious of these is an Achilles tendon rupture. This occurs when the tendon literally tears in half, so that there is no more connection between the muscle and the bone. Often times, there will be an audible “pop” and a sensation of someone kicking you from behind. There will be pain and weakness when your foot is pushing off the ground. It’s important to note that those that have Achilles tendon ruptures will still be able to push off with their foot since there are other accessory muscles that have this function. Similarly, often times ruptures are not as painful as one may think. Underestimating the extend of injury initially can lead to adverse consequences later on.
Chronic symptoms on the other hand develop more insidiously. The Achilles tendon will start to hurt more with activity, especially with downhill and jumping activity. As time goes on, pain will get worse and start hurting with less activity. The tendon itself starts degenerating and a “bump” and permanent swelling of the tendon may develop.
Achilles tendonitis may also develop as an overuse injury, where small tears in the fibers of the tendon start to break it down. This can feel like pain down the back of the leg and the heel. It’s important to contact a doctor as tendonitis can progress quickly and become worse.
How do I treat an Achilles tendon injury?
Treatment for these injuries depends on the acuity and the goals of the patient. Any acute injury where rupture is suspected should be seen and evaluated by an orthopaedic surgeon. Prompt recognition and treatment of these injuries are paramount to ensure an optimal outcome. A rupture can be diagnosed with clinical exam alone, and an MRI is not necessary. In young, healthy, and active patients, surgical treatment offers the best chance to return to full pre-injury function and lowest chance of re-injury. In these cases, I utilize a technique which minimizes the size of the incision which decreases the risk of wound issues postoperatively. Recovery time means different things to different people, but one should expect to return to pre-injury activity at about six to nine months.
For more chronic Achilles disorders, an initial period of nonoperative treatment is utilized first. This usually consists of physical therapy, anti-inflammatory medications, and activity modification. I would strongly discourage injections of corticosteroid, as this can lead to rupture of the tendon. If these measures fail, an MRI would then be utilized and a variety of surgical procedures can be utilized to remove the diseased tendon, add strength to the remaining tendon, and remove any bone that might be “rubbing against” the tendon.
If you’re dealing with pain in your foot or ankle, you may have an Achilles tendon injury. Schedule an appointment with your doctor at the first signs of pain to prevent further damage.