Dr. Anderson explains why prompt care is important when the Achilles tendon is damaged.
The fabled vulnerability of the Achilles tendon is rooted in Greek mythology. The goddess Thetis dipped her son Achilles into the magical waters of the River Styx to protect him from injury. But according to the myth, she held him by his ankle so his heel remained dry and vulnerable. A heel wound was his downfall in the Trojan war.
The anatomy of the Achilles tendon
“Contrary to mythology’s warning, the tendon named after Achilles is actually a pretty tough band of tissue,” grins foot and ankle specialist Dr. Michael Anderson. “It’s the largest tendon in the body, running down the back of the lower leg to connect the calf muscles to the heel bone. We depend on this tendon to raise our heel off the ground when we run, jump, and walk.”
Causes of Achilles tendon injury
Although the Achilles tendon is designed to withstand stress, it is still vulnerable to injury. “Athletes, people with physically demanding jobs, and weekend warriors are most at risk for tendon injuries,” notes Dr. Anderson. “They are most likely to repeatedly put stress on their ankles and feet. When you subject the Achilles tendon to a sudden increase of repetitive heel activity, it causes micro-injury to the tendon fibers. If you don’t give your body time to rest and repair the injured tissue, continued stress can degenerate the tendon. In the worst case scenario, it can cause a rupture of the tendon.”
Three Achilles tendon injuries
“The two Achilles tendon injuries I treat most often are Achilles tendinitis and Achilles tendinosis,” says Dr. Anderson. “Tendon ruptures are less common, but I see those too.
- Achilles tendinitis. This condition occurs when the tendon becomes irritated and inflamed, often as the result of injury. Tendinitis can affect two sites on the tendon. When the irritation occurs in the middle of the tendon, above the ankle, it’s called noninsertional Achilles tendinitis. Irritation at the base of the tendon, where it attaches to the heel, is called insertional Achilles tendinitis. At both sites, tendinitis can cause damaged fibers to swell, calcify, and harden. Extra bone growth, or bone spurs, may accompany insertional tendinitis.
- Achilles tendinosis. Under repeated stress over time, the Achilles tendon experiences slow progressive degeneration, developing microscopic tears. Like tendinitis, tendinosis can occur in the middle of the tendon, or where it attaches to the heel bone.
- Achilles tendon rupture. Complete tendon ruptures are usually the result of an acute sports injury. These ruptures usually occur in the middle of the tendon, but the tendon can also tear away from the heel bone. “Male athletes over the age of 40 are most at risk as their tissues become less elastic,” notes Dr. Anderson. “I also caution women about stressing the Achilles tendon by regularly alternating high heels and running shoes. Heels shorten the calf muscles over time; the switch to a flat shoe can put sudden demands on the Achilles tendon.”
Symptoms of Achilles tendon injury
The symptoms associated with Achilles injuries include:
- Pain. “Patients report feelings of soreness or tightness accompanying a damaged tendon,” says Dr. Anderson. “Pain often appears in the morning or after sitting for a long period. It may be difficult to climb stairs or run.”
- Tenderness. Pressing directly on the back of the tendon may not be painful, but tenderness is most pronounced when the sides of the tendon are squeezed.
- Reduced mobility. Tendon damage often limits range of motion in the ankle, making it more difficult to flex the foot.
- Swelling and nodules.” As the tendon degenerates,” Dr. Anderson explains, “it may become enlarged or develop nodules at the point where the tissue is damaged.”
- Snapping sensation. If the tendon ruptures, a patient may feel acute pain accompanied by a snapping sensation.
Nonsurgical treatment for Achilles injuries
“A treatment plan for Achilles injury is guided by the degree of damage to the tendon,” explains Dr. Anderson. “When we can address damage early, these injuries can often be treated nonsurgically with immobilization, ice to reduce swelling, and medications such as ibuprofen to reduce inflammation. We might also consider physical therapy to strengthen the leg, stretch the calf muscles, and improve mobility.”
Surgical treatment for Achilles injuries
When conservative treatment fails to restore the tendon, surgical options may be considered. “Surgery can successfully return many patients to full function and performance,” says Dr. Anderson. “At Summit, we offer expertise in an array of focused surgical tendon treatments. When I’m considering surgery with a patient, we review surgical repair options based on the extent of the injury, the patient’s age, and activity goals. Together, we choose the treatment that best meets patient objectives.”
Summit Orthopedics offers personalized foot and ankle expertise
Our fellowship-trained foot and ankle physicians understand that your mobility depends on the health of your feet and ankles. If you have suffered an injury or are experiencing symptoms that make walking painful, our team of foot and ankle specialists can help with conservative treatment, seasoned surgical teams, and expert rehabilitation support. Summit Orthopedics specialists have the expertise to evaluate your discomfort and develop a plan to quickly and safely get you back on your feet and on your way.
Start your journey to optimal foot health. Find your foot and ankle expert, request an appointment online, or call us at (651) 968–5201 to schedule a consultation.
Summit has convenient locations across the Minneapolis-St. Paul metro area, serving Minnesota and western Wisconsin. We have state-of-the-art centers for comprehensive orthopedic care in Eagan, MN, Plymouth, MN, Vadnais Heights, MN, and Woodbury, MN, as well as additional community clinics throughout the metro and southern Minnesota.
Tendon related resources
- Learn more about tendinitis and tendinopathy
- Check out a new treatment for chronic tendon pain
- Ask Dr. Scofield: What Can Runners Do To Reduce The Risks Of Achilles Tendonopathy?
- Ask Dr. Scofield: Which Tendon Treatment Is Right for Me?
- Ask Dr. Anderson: What’s the Best Achilles Tendon Repair?
Additional resources for you
- Ask Sam Olson: Does My Running Shoe Matter?
- Ask Dr. Scofield: Guidelines For Transitioning To A New Running Shoe
- Watch the video: Introducing Dr. Michael Anderson
- Read about how your shoes can affect your foot health