The Achilles tendon, which is the largest and strongest tendon in the body, is a tough band of fibrous tissue that connects the calf muscles to the heel bone (calcaneus). The two calf muscles, the gastrocnemius and soleus, come together to form the Achilles tendon at the low end of the calf. The Achilles tendon then inserts into the calcaneus. When the calf muscles flex, the Achilles tendon pulls on the heel. This movement allows us to stand on our toes when walking, running, or jumping. The Achilles tendon can be easily injured due to its limited blood supply and the high tensions placed on it.
Conditions of the Achilles tendon
Achilles tendon tear: Tears of the Achilles tendon can be tiny (microtears), or large, causing pain, swelling, and impaired movement. They may occur suddenly during activity, or gradually over time.
Achilles tendon rupture: A complete rupture of the Achilles tendon may make a “pop” sound, followed by pain and swelling of the lower leg. Treating an Achilles tendon rupture requires surgery or long-term immobilization of the ankle.
Achilles tendinosis: Gradual thickening of the Achilles tendon without apparent inflammation, due to aging or overuse. Despite the thickening, the tendon is weakened and prone to injury or rupture.
Achilles or heel (calcaneal) bursitis: Low-riding shoes can irritate the bursa, a sac of fluid cushioning the Achilles tendon at the heel. Pain in the back of the heel, worse with shoes on, is the common symptom.
Achilles tendonitis: Frequent activity (running or walking) can gradually inflame the end of the Achilles tendon, causing pain and stiffness at the back of the heel. Rest, ice, and stretching may speed healing, which can take weeks. Achilles tendonitis most commonly occurs in runners who have suddenly increased the intensity or duration of their runs. It’s also common in middle-aged people who play sports, such as tennis or basketball, only on the weekends (weekend warriors).
More-serious cases of Achilles tendonitis can lead to tendon tears (ruptures) that may require surgical repair.
Prevention of Achilles tendonitis
While it may not be possible to prevent Achilles tendonitis, you can take measures to reduce your risk.
Increase your activity level gradually: If you’re just beginning an exercise regimen, start slowly and gradually increase the duration and intensity of the training.
Take it easy: Avoid activities that place excessive stress on your tendons, such as hill running. If you participate in strenuous activity, warm up first by exercising at a slower pace. If you notice pain during a particular exercise, stop and rest.
Choose your shoes carefully: The shoes you wear while exercising should provide adequate cushioning for your heel and should have firm arch support to help reduce the tension in the Achilles tendon. Replace your worn-out shoes. If your shoes are in good condition but don’t support your feet, try arch supports in both shoes.
Stretch daily: Take the time to stretch your calf muscles and Achilles tendon in the morning, before exercise and after exercise to maintain flexibility. This is especially important to avoid a recurrence of Achilles tendonitis.
Strengthen your calf
muscles: Strong calf muscles enable the calf and Achilles tendon to better handle the stresses they encounter with activity and exercise.
Cross-train: Alternate high-impact activities, such as running and jumping, with low-impact activities, such as cycling and swimming.
Achilles tendonitis tests
Physical examination: To look for Achilles tendon problems, an examiner checks for pain, swelling, warmth, thickening, or discoloration around the heel and leg. A knot on the back of the leg may be present with an Achilles tendon rupture.
Magnetic resonance imaging (MRI) scan: An MRI scanner uses a high-powered magnet and a computer to create highly detailed images of the ankle and leg. An MRI scan is the best test to diagnose an Achilles tendon rupture or other problems, but it may not always detect tendinopathy.
Achilles tendon ultrasound: A probe on the skin reflects high-frequency sound waves off the ankle, producing images of the Achilles tendon. Ultrasound can often diagnose an Achilles tendon rupture.
X-rays: A plain x-ray film may identify problems with the bones or ankle joint, but it cannot diagnose Achilles tendon problems.
Achilles tendonitis treatment
RICE therapy: Most Achilles tendon injuries can be treated with RICE: rest, ice, compression with a sports bandage, and elevation.
Pain relievers: Over-the-counter medicines like acetaminophen (Tylenol), ibuprofen (Motrin), and naproxen (Aleve) can lessen the pain of most Achilles tendon problems. For more severe pain, prescription pain relievers may be necessary.
Heat: Alternating ice and heat therapy may improve the pain of bursitis near the Achilles tendon.
Footwear: Wearing shoes with good support that are right for your feet may help avoid more injury to the Achilles tendon. Custom-made orthotics, heel lifts, and certain splints and braces are sometimes helpful. It is best to avoid being barefooted or wearing flat shoes or sandals.
Physical therapy: Although modifying or decreasing activity is important, particular stretches and exercises may be helpful to rehabilitate tendon problems, especially when they are persistent.
Immobilization: Many moderate to severe Achilles tendon conditions require immobilization of the ankle joint. This may require wearing a special boot or a leg cast for several weeks.
Achilles tendon surgery: Surgery can often re-attach a ruptured Achilles tendon. If there is extra bone present on the heel, it may be removed in surgery. Following surgery, immobilization of the ankle is necessary for several weeks.
If you experience persistent pain around the Achilles tendon or in the back of the heel, call your doctor right away and seek medical attention.
• For more information or to see a podiatrist, visit Bahamas Foot Centre, Rosetta Street, telephone 325-2996; or Bahamas Surgical Associates Centre, Albury Lane, telephone 394-5820; or email firstname.lastname@example.org; or visit www.apma.org.