Tendons are cords of tough, fibrous tissue that connect muscles and bones. The Achilles tendon, which connects your calf muscles to your heel, is the thickest and strongest of all the tendons in your body. It plays a critical role in enabling you to walk, run, jump, and exercise. The Achilles tendon is subject to a variety of potential injuries, which can cause pain, limit mobility, and decrease participation in sports and other recreational activities.

An injury to the Achilles tendon may require treatment by an orthopedic or sports-medicine specialist. The health care providers at Baptist Health have been treating injured Achilles tendons for more than 90 years.

What Are Common Achilles Tendon Injuries? What Are Their Symptoms?

Two common Achilles tendon injuries are tendinitis and ruptures. Tendinitis occurs when small tears develop in the tendon’s middle fibers or where it connects to the heel bone. A rupture is a partial or complete severing of the tendon itself. Both conditions are painful, but a rupture is more serious; it requires prompt medical attention.

Symptoms of tendon injuries include:

• Pain in your lower leg or heel
• Leg pain that occurs during or after exercise
• Soreness in the Achilles tendon, especially upon waking up
• Swelling, redness, and pain that worsen with activity
• Thickening of the tendon
• Bone spurs on the calcaneus or heel bone
• An inability to stand on your toes or to use your foot for pushing off when walking
• A loud popping sound, accompanied by severe pain, often indicating a rupture
• A lump like deformity in the back of the lower leg, often indicating a rupture

What Causes Achilles Tendon Injuries?

Tendon injuries result from high levels of stress sustained by the feet and ankles, especially during periods of physical exertion. Factors contributing to injury may include:

• Participation in a new sport
• Running uphill or on broken surfaces
• Failure to warm up appropriately before exercise
• Slips and falls
• Stepping into holes
• Poor fitting shoes and footwear
• Flat arches, weak calf muscles, and bone spurs
• Risk factors for Achilles Tendon Injury

A number of variables affect your chances of an Achilles tendon injury:

• Participation in sports: Athletic activity increases the likelihood of achilles tendon injury. This is particularly true for sports with frequent stops and starts, several hops and jumps, or abrupt changes in direction.
• Being overweight: Increases in body weight have to be supported by the ankle and heel – and the tendon that connects them.
• Age: Tendon problems can occur at any age but tendinitis is most common in the active young. The peak period for ruptures is during a person’s fourth decade (ages 31 to 40).
• Sex: Men experience Achilles tendon ruptures at a rate of 5 to 1 over women.
• Steroid injections: While temporarily curbing pain, steroid injections in ankle joints have also been linked to a weakening of the Achilles tendon.
• Antibiotic intake: Certain antibiotics have also been linked to weakened tendons and an increase in ruptures.

How Do I Prevent Achilles Tendon Injuries?

There are several steps you can take to decrease the possibility of a tendon injury:

• Warm up before exercising or playing recreational sports: Stretch out your calf muscles prior to exercise or a sporting activity. Also recommended are exercises that target the calf muscles for development.
• Avoid uneven running or playing surfaces: Steer clear of any surface that is conducive to slipping, falling, or twisting an ankle.
• Vary your exercise routine: Ensure that your regimen includes some healthy, low-impact activities, such as walking, swimming, bicycling, or elliptical training.
• Increase physical exertion gradually: Serious injuries often occur after abrupt increases in exercise frequency or intensity. Increase your workload slowly, a little bit every week.

How Are Achilles Tendon Injuries Diagnosed?

If you develop lower leg pain, or pain and dysfunction in your heel and foot, you should see a physician. The diagnosis of an Achilles tendon injury typically involves:

• Documentation of your health and medical history
• A write-up of your symptoms
• A physical examination of your Achilles tendon, with an eye to inflammation, bone spurs, and/or sources of pain
• Range-of-motion tests for ankle and foot
• X-ray or MRI scans of the Achilles tendon looking for evidence of hardening (called calcification) or associated growths, such as bone spurs

How Are Achilles Tendon Injuries Treated?

The treatment of tendon injuries depends on their severity. Tendinitis is often addressed through:

• Rest, ice packs, and pain-relief medication (typically NSAIDs, such as naproxen or ibuprofen)
• Muscle-strengthening exercises
• Physical therapy
• Low-impact aerobic activities, such as swimming
• Casts, splints, walking boots, or orthotic shoes

More serious injuries, such as ruptures, may call for surgical procedures that remove damaged tissue, lengthen calf muscles, or reattach tendon to bone.

Complications

The following complications may result from an Achilles tendon injury:

• Pain (sometimes severe)
• Decreases in mobility and extent of physical activity
• Damage to or deformation of the tendon or heel bone
• Possibility of reinjury

Tendon injuries can be debilitating and slow to heal. Nevertheless, with patience and proper treatment, you can experience a successful recovery.