top.gif (4133 bytes)

Achilles Tendon Injury


What is an Achilles tendon injury?


How does it occur?


What are the symptoms?


How is it diagnosed?


How is it treated?


When can I return to my sport or activity?


How can I prevent Achilles tendonitis?


ankle_achilles.JPG (42738 bytes)
click on image for large view


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. In the image above the left heel shows an enlarged area of inflammation just above the heel bone.

An Achilles tendon may tear, or rupture, during sudden activity such as with jumping, lunging, or at the beginning of a sprint. The tear is commonly seen in middle aged men playing squash or basketball.

How does it occur?

Achilles tendonitis can be caused by:

Violent stretching of the Achilles tendon during sports can cause it to rupture.

What are the symptoms?

Achilles tendonitis causes pain  and swelling along the course of 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.

How is it diagnosed?

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.

For rupture of the tendon, your doctor should palpate the tendon while you are lying face down. He should also perform the Thompson test.

achilles_defect_animation.gif (190867 bytes)

This animation demonstrates the defect in the tendon that is seen with a rupture of the tendon. Click on the picture to start the animation.

The Thompson Test

achilles_thompson-animation.gif (170716 bytes)
The test is performed with the patient lying face down. The calf muscle is squeezed. The ankle on the normal side will flex down. The ankle with the torn tendon does not flex. (the tendon is not attached to the heel bone)


How is it treated?

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 be treated with either surgery or your foot may be placed in a cast for 6 to 10 weeks. The decision is usually based on your activity level. A young competitive high jumper may be treated with surgical repair. A middle aged sedentary clerical worker may be treated with a cast. The advantages of the surgical treatment is a prompt return to sport (4-6 months) with  strong   ankle flexion. The disadvantage is the potential for infection (<1%) and re-rupture (<4%) The advantages of the cast treatment is avoidance of a surgical procedure, but the re-rupture rate is 8% with a surgical procedure necessary at that time. Return to vigorous activities with the cast treatment is generally 9-12 months.

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:

For rehabilitation exercises for Achilles tendonitis, click here

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.