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Achilles Tendon Injury
What is an Achilles tendon injury?
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What is an Achilles tendon injury?
Tendons are connective tissue bands that attach muscles to bones. Achilles tendonitis is inflammation in the tendon of the calf muscle near where it attaches to the heel bone. The inflammation causes pain at the back of your leg near the heel.
An Achilles tendon may tear, or rupture, during sudden activity such as with jumping or at the beginning of a sprint.
Achilles tendonitis can be caused by:
- overuse of the Achilles tendon
- tight calf muscles
- tight Achilles tendons
- lots of uphill running
- increasing the amount or intensity of training, sometimes along with switching to racing flats, racing shoes with less heel lift
- over-pronation, a problem where your feet roll inward and flatten out more than normal when walking or running
- wearing high heels at work and then switching to a lower heeled workout shoe.
Violent stretching of the Achilles tendon can cause it to rupture.
Achilles tendonitis causes pain and may cause swelling over the Achilles tendon. The tendon will be tender and may be swollen. You will have pain when you rise up on your toes and pain with stretching of the tendon. The range of motion of your ankle may be limited.
When it tears or ruptures, you may feel a pop. If there is a complete tear, you will be unable to lift your heel off the ground or point your toes.
Your doctor will examine your leg, looking for tenderness and swelling. By watching you as you walk or run, your doctor can determine if you over-pronate.
Apply ice packs to the Achilles tendon for 20 to 30 minutes every 3 to 4 hours for the first 2 or 3 days or until the pain goes away. Raise your lower leg on a pillow when you are lying down.
Your doctor may prescribe an anti-inflammatory medication. Your doctor may also prescribe a heel lift insert for your shoe to prevent extra stretching of your Achilles tendon. You will need to wear the heel lift at least until your Achilles tendon heals and possibly longer.
While you are recovering from your injury, you will need to change your sport or activity to one that does not make your condition worse. For example, you may need to swim instead of run.
If you over-pronate, your doctor may prescribe custom-made shoe inserts, called orthotics, which help keep your foot stable. You will be given exercises to stretch and strengthen your Achilles tendon. In some severe cases of Achilles tendonitis, you may be placed in a cast for several weeks.
An Achilles tendon rupture or tear may require surgery, or your foot may be placed in a cast for 6 to 10 weeks.
When can I return to my sport or activity?
The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity is determined by how soon your Achilles tendon area recovers, not by how many days or weeks it has been since your injury occurred.
You may safely return to your sport or activity when, starting from the top of the list and progressing to the end, each of the following is true:
- You have full range of motion in the injured leg compared to the uninjured leg.
- You have full strength of the injured leg compared to the uninjured leg.
- You can jog straight ahead without pain or limping.
- You can sprint straight ahead without pain or limping.
- You can do 45-degree cuts, first at half-speed, then at full-speed.
- You can do 20-yard figures-of-eight, first at half-speed, then at full-speed.
- You can do 90-degree cuts, first at half-speed, then at full-speed.
- You can do 10-yard figures-of-eight, first at half-speed, then at full-speed.
- You can jump on both legs without pain and you can jump on the injured leg without pain.
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How can I prevent Achilles tendonitis?
Achilles tendonitis is best prevented by stretching your calf muscles and Achilles tendons before doing your activities. If you have tight Achilles tendons or calf muscles, it is a good idea to stretch these twice a day whether or not you are doing any sports activities that day. If you have a tendency to get Achilles tendonitis, it is a good idea to avoid doing a lot of uphill running.
Written by Pierre Rouzier, M.D., for Clinical Reference Systems.
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