Your Achilles tendon is a fibrous band of tissue that links the muscles in your calf to your heel. Its strength and flexibility are important for jumping, running, and walking. Your Achilles tendon withstands a lot of stress and pressure during everyday activities, as well as during athletic and recreational play.
Occasionally, your health care provider will misdiagnose your tendon injury as a sprained ankle. It is important to get the right diagnosis so you can get the right treatment. Several common injuries can make your Achilles tendon painful or prevent it from working well.
The Achilles tendon is the largest tendon in the body. It connects the two main calf muscles - the gastrocnemius and soleus - to the heel bone (the calcaneus). Common injuries of the Achilles tendon include tendonitis (inflammation), tendinosis (degeneration), and rupture.
Your Achilles tendon can become inflamed — swollen and irritated. This may happen because of overuse or damage to the area. Tendinitis can cause pain down the back of your leg and around your heel. You might notice that parts of your tendon are getting thicker, and hardening, because of tendinitis. This is a degenerative condition, which means it will get worse if you don't treat it.
Noninsertional Achilles tendinitis. Small tears in the middle fibers of your tendon start to break it down. This causes pain and swelling. This type of tendinitis usually affects active, younger adults
Insertional Achilles tendinitis. This occurs in the spot where your tendon meets your heel bone, if the fibers in your tendon tear. Bone spurs also can grow out of the heel bone tissue, causing pain
It is possible for the tears in your tendon fibers to break your tendon completely or partially. You might hear a “pop” that seems to come from the back of your heel or calf. A rupture needs immediate medical attention.
Symptoms of tendon injuries include:
Thickening of your tendon
Pain down the back of your leg or near your heel
Pain that gets worse when you're active
A stiff, sore Achilles tendon when you first get up
Pain in the tendon the day after a workout
Swelling with pain that gets worse as you're active during the day
Bone spurs on the heel bone
Difficulty flexing the affected foot
A “pop” sound accompanied by sudden sharp pain, which suggests a ruptured tendon
Who’s at risk
Anyone can develop tendinitis. The most common risk factors are:
Increased activity or a new sport
Tight calves, which can place more stress on your tendon
Bone spurs on your heel, which can aggravate your tendon
The wrong shoes or on uneven surface when you exercise
Treatment with fluoroquinolone, an antibiotic medication
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To diagnose your condition, your physician will consider:
Your overall health and medical history
A description of your symptoms
A physical examination of your Achilles tendon. This checks for bone spurs, pain, and swelling
A test of your ankle's range of motion
Imaging tests, such as X-ray or magnetic resonance imaging (MRI). Your doctor will use MRI most often to determine the extent of your tendon damage.
Treatment depends on how badly injured your tendon is. It may include:
Low-impact exercise alternatives, such as swimming
Nonsteroidal anti-inflammatory drugs for pain relief
Specific exercises to strengthen your calf muscles
Eccentric strength training. This is a system of exercises that help strengthen your calf muscles to take pressure off your tendon
Heel lifts in shoes
A walking boot
Extracorporeal shockwave therapy. This is a controversial treatment your doctor may recommend to see whether you can improve without surgery
Surgery to lengthen your calf muscles
Debridement surgery to remove damaged tendon tissue or bone spurs
Surgery to remove your damaged tendon tissue. The type of surgery depends on the amount of damage to your tissue and other factors, such as the severity of the tendinitis.
Complications of an Achilles tendon injury may include:
Pain, which can be severe
Difficulty walking or being active
Deformation of your tendon area or heel bone
Need for surgery
Tendon rupture from the injury. Occasionally, cortisone injections also can cause your tendon to tear.
You can prevent injury to your Achilles tendon by:
Increasing activity gradually, rather than all at once
Wearing the correct shoes for your activities
Not exercising on uneven surfaces
Being aware of the risks of fluoroquinolone and exercising with caution if you’re taking this drug
When to call the doctor
Call your doctor immediately if you experience a “pop” sound and acute pain from the back of your leg or heel. Otherwise, schedule an appointment if pain or difficulty moving interferes with your regular daily activities.
How to manage or live with the condition
Follow your doctor’s recommendations to get rest and manage pain and swelling. Choose alternative ways to be active. Try low-impact activities that do not place a lot of stress on your tendon, such as swimming or bicycling, rather than a high-impact exercise like running. Always let your doctor know if these strategies don’t help reduce pain, swelling, and loss of function.