The Achilles tendon (often simply called the ‘Achilles’) is the thick cord you can feel at the back of your ankle. It attaches the calf muscle to the back of your heel.
An Achilles tendon injury can happen to anyone, whether you’re an athlete or just going about your everyday life.
An Achilles tendon injuries can happen to anyone, whether you’re an athlete or just going about your everyday life.
The Achilles tendon is the largest tendon in your body. It stretches from the bones of your heel to your calf muscles. You can feel it: a springy band of tissue at the back of your ankle and above your heel. It lets you point your toes toward the floor and raise up on your tiptoes.
The Achilles tendon is a tough band of fibrous tissue that connects the calf muscles to the heel bone (calcaneus). The Achilles tendon is also called the calcaneal tendon.
The gastrocnemius and soleus muscles (calf muscles) unite into one band of tissue, which becomes the Achilles tendon at the low end of the calf. The Achilles tendon then inserts into the calcaneus. Small sacs of fluid called bursae cushion the Achilles tendon at the heel.
The Achilles tendon is the largest and strongest tendon in the body. 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. Despite its strength, the Achilles tendon is also vulnerable to injury, due to its limited blood supply and the high tensions placed on it.
The 2 most common injuries of the Achilles tendon are:
Acute rupture: a complete or partial tear that occurs when the tendon is stretched beyond its capacity.
Achilles tendinopathy: a chronic (long-term) condition that causes weakness and degeneration of the Achilles due to a series of very small tears (tendinosis).
The Achilles (calcaneal) tendon is a common tendon shared between the gastrocnemius and soleus muscles of the posterior leg. It connects the two muscle groups (collectively, triceps surae) to the calcaneus. Generally, the tendon winds 90 degrees on its path towards the heel, such that the gastrocnemius attaches laterally and the soleus attaches medially. It is the thickest tendon in the human body and has the capacity to withstand large tensile forces.
What Are Achilles Tendon Injuries?
The Achilles tendon is a fibrous band of tissue that links the muscles in your calf to your heel. The strength and flexibility of this tendon are important for jumping, running, and walking. Your Achilles tendon bears a lot of stress and pressure during everyday activities, as well as during athletic and recreational play. If it becomes inflamed, swollen, and irritated, it’s called tendonitis.
What Causes Achilles Tendon Injuries?
Achilles tendon injuries can be caused by the following:
Tendonitis might be due to overuse or damage to the area. It 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 tendonitis. This will get worse if you don’t treat it. There are two main types of tendonitis:
- Noninsertional Achilles tendonitis. Small tears in the middle fibers of your tendon start to break it down. This causes pain and swelling. This type of tendonitis usually affects active, younger adults.
- Insertional Achilles tendonitis. This damage occurs in the spot where your tendon meets your heel bone. Bone spurs (extra bone growth) often form with this type. This type of tendonitis can happen at any age, even in people who aren’t active.
The tears in your tendon fibers can cause a complete or partial break (or tear) in your tendon. You might hear a pop that seems to come from the back of your heel or calf. This may be a tendon rupture, which needs immediate medical attention.
Achilles Tendon Injuries Symptoms
The most obvious sign is pain above your heel, especially when you stretch your ankle or stand on your toes. It may be mild and get better or worse over time. If the tendon ruptures, the pain is instant and severe. The area may also feel tender, swollen, and stiff.
If your Achilles tendon tears, you may hear a snapping or popping noise when it happens. You could have bruising and swelling, too. You also may have trouble pointing your toes and pushing off your toes when you take a step.
Common symptoms of tendon injuries include:
- 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 exercising
- Swelling with pain that gets worse as you’re active during the day
- Thickening of your tendon
- Bone spurs on the heel bone
- Difficulty flexing the affected foot
- A pop sound and sudden sharp pain, which can mean a ruptured tendon
Achilles Tendon Conditions
- 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 (formerly tendonitis): Frequent activity (running or walking) causes an over use of 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 peritendonosis: Similar to Achilles tendonosis, but pain occur in the tissue surrounding the tendon caused by over use, often two or more inches above the heel.
- Achilles tendinosis: Gradual thickening of the Achilles tendon, due to aging or overuse. Despite the thickening, the tendon is weakened and prone to further injury or rupture.
- Achilles tendinopathy: A general term for tendinitis or tendinosis affecting the Achilles tendon.
- 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.
How Is An Achilles Tendon Injury Diagnosed?
Doctors sometimes mistake an Achilles tendon injury for sprained ankle. To make the right diagnosis, your doctor will start with a physical exam. They may want to see you walk or run so they can look for problems that might have led to your injury.
They also might do something called the calf squeeze test. You’ll kneel on a chair or bench or lie on your stomach on the exam table. Your doctor will gently squeeze the calf muscle on your healthy leg. This will pull on the tendon and make your foot move. Next, they’ll do the same thing on your other leg. If your Achilles tendon is torn, your foot won’t move, because your calf muscle won’t be connected to your foot.
Your doctor may test your range of motion to see if you can move your ankle the way you should. They may also do imaging tests, such as X-ray or MRI. These tests can show what kind of tendon damage you have and help them decide on the best treatment for you.
How Are Achilles Tendon Injuries Treated?
Treatment depends on how badly injured your tendon is. It may include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief, such as ibuprofen or naproxen
- Specific exercises to strengthen your calf muscles
- Physical therapy
- Eccentric strength training. This type of exercise helps strengthen your calf muscles to take pressure off your tendon
- Low-impact activities, such as swimming
- Heel lifts in shoes, orthotic shoes, cast, splint, or a walking boot
- Extracorporeal shockwave therapy. This treatment uses high-energy shockwave impulses to help stimulate the healing process in damaged tendon tissue. This treatment isn’t often used. However, your healthcare provider may recommend it to see whether you can improve without surgery
If these treatments don’t work or if the injury is severe or complete, surgery may be considered. The type of surgery depends on the location and amount of damage to the tendon. It can also depend on other things, such as the severity of the tendonitis. Some of the surgical procedures used include:
- Surgery to lengthen your calf muscles (gastrocnemius recession)
- Surgery to remove damaged tendon tissue or bone spurs and repair the tendon (debridement)
- Surgery to remove your damaged tendon tissue, fix the remaining tendon, and give it extra strength by moving another tendon to the heel bone
Achilles Tendon Injury Recovery
Recovery may take months, but it depends on how serious your injury is. Different conditions heal at different rates.
You can still be active while your injury heals. Ask your doctor what’s OK to do. But don’t rush things. Don’t try to return to your old level of physical activity until:
- You can move your leg as easily and freely as your uninjured leg.
- Your leg feels as strong as your uninjured leg.
- You don’t have any pain in your leg when you walk, jog, sprint, or jump.
If you push yourself too much before your Achilles tendon injury fully heals, you could get injured again, and the pain could become a long-lasting problem. You may be able to avoid some of these issues if you replace high-impact sports like running with low-impact exercise. Activities such as swimming or cycling put less stress on your tendon.
How Can Achilles Tendon Injuries Be Prevented?
Since a lack of flexibility is a major cause of injury, proper stretching of the lower leg is the most basic way to prevent Achilles tendon strains or tears. As is the case with many other conditions injuries, it is important to stay as fit as possible during the healing and rehabilitation process. Swimming and other non-impact exercises are best, including bicycling, if that activity does not cause any pain (which would indicate a liklihood of reinjury). Running should be avoided at all costs until a rehabilitation specialist, trainer or doctor advises that sufficient recovery has taken place.
You can help protect your Achilles tendons by:
- wearing supportive shoes
- warming up and stretching before and after exercise
- gradually building up your level of physical activity
- resting between workouts
- doing exercises that strengthen your calf muscles