The Achilles tendon connects the calf muscle to the heel bone. It lets you rise up on your toes and push off when you walk or run.
The two main problems found in the Achilles tendon are:
Problems with the Achilles tendon may seem to happen suddenly. But usually they are the result of many tiny tears to the tendon that have happened over time.
Achilles tendon problems are most often caused by overuse or repeated movements. These movements can happen during sports, work, or other activities. For example, if you do a lot of pushing off or stop-and-go motions when you play sports, you can get microtears in the tendon. Microtears can also happen with a change in how long, hard, or often you exercise. Microtears in the tendon may not be able to heal quickly or completely.
Being out of shape or not warming up before exercising may also cause Achilles tendon problems. So can shoes with poor arch supports or rigid heels.
An Achilles rupture is most often caused by a sudden, forceful motion that stresses the calf muscle. This can happen during an intense athletic activity or even during simple running or jumping. Middle-aged adults are especially likely to get this kind of injury.
A rupture most often occurs in sports such as basketball, racquet sports (including tennis), soccer, and softball. A tendon already weakened by overstretching, inflammation, or small tears is more likely to rupture.
Symptoms of Achilles tendon problems include swelling in the ankle area and mild or severe pain. The pain may come on gradually or may only occur when you walk or run. You may have less strength and range of movement in the ankle.
A rupture of the Achilles tendon may cause a sudden, sharp pain. Most people feel or hear a pop at the same time. Swelling and bruising may occur, and you may not be able to point your foot down or stand on your toes.
Your doctor can tell if you have an Achilles tendon problem by asking questions about your past health and checking the back of your leg for pain and swelling. The doctor may ask: How much pain do you have? How did your injury happen? Have you had other injuries in the ankle area?
Treatment for mild Achilles tendon problems includes rest, over-the-counter pain medicine, and stretching exercises. You may need to wear well-cushioned shoes and change the way you play sports so that you reduce stress on the tendon. Early treatment works best and can prevent more injury.
Even in mild cases, it can take weeks to months of rest for the tendon to repair itself. It’s important to be patient and not return too soon to sports and activities that stress the tendon.
Treatment for severe problems, such as a torn or ruptured tendon, may include surgery or a cast, splint, brace, walking boot, or other device that keeps the lower leg from moving. Exercise, either in physiotherapy or in a rehab program, can help the lower leg get strong and flexible again. The tendon will take weeks to months to heal.
Although treatment for Achilles tendon problems takes time, it usually works. Most people can return to sports and other activities.
Frequently Asked Questions
Learning about Achilles tendon problems:
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Achilles tendinopathy is most often caused by:
Achilles tendon rupture is most often caused by:
Symptoms of Achilles tendinopathy may include:
Symptoms of an Achilles tendon rupture may include:
If you have a partial rupture (tear) of the Achilles tendon, you may have near-normal strength and less pain after the initial injury, compared to what you experience after a complete rupture.
Achilles tendinopathy starts with repeated small tears in the tendon, causing no obvious symptoms or mild to severe pain during movement. As the tearing continues, the leg may weaken and the tendon pain may become constant. Abnormal growths (nodules) may develop in the tendon. And it may thicken.
Resting and treating your injured Achilles tendon will likely reduce the pain. Stretching and exercising in physiotherapy or a rehabilitation (rehab) program will restore flexibility and strength in your lower leg. Warming up the lower leg and Achilles tendon will help promote healing and keep the condition from getting worse as you resume more intense activities, such as sports or stair climbing.
Without rest and treatment of Achilles tendinopathy, you may develop long-lasting (chronic) pain.
A tear usually occurs in the tendon about 4 cm (1.5 in.) to 6.5 cm (2.5 in.) above its attachment to the heel bone. Some doctors believe that this area is most likely to tear or rupture because of a limited blood supply.
If you treat an Achilles rupture with:
If you do not treat an Achilles rupture, you will feel weakness in the first steps when walking, with a feeling similar to that of walking in the sand. Eventually, walking will become difficult.
Other conditions can affect the Achilles tendon area alone or along with tendinosis. These other conditions are caused by inflammation and include:
Risk factors for an Achilles tendon rupture include:
Call your doctor immediately if you think you have an Achilles tendon problem (at or above the back of your ankle) and:
If you have had an Achilles tendon injury in the past and you have reinjured your Achilles tendon, call your doctor to find out what you need to do. Rest your lower leg and foot until treatment begins.
Watchful waiting is a period of time during which you and your doctor observe your symptoms or condition without using medical treatment. Watchful waiting is not appropriate if you have severe pain in the Achilles tendon area. If you think you have injured your Achilles tendon, call your doctor. Early treatment is most effective in healing the Achilles tendon.
If you think you have Achilles tendinopathy, rest your lower leg and foot for a couple of days and avoid any hard activity. Use ice and pain-relieving medicines to reduce the pain and swelling, and follow the other steps in the Home Treatment section of this topic. If you have weakness, cramping, or constant pain in your Achilles tendon, call your doctor.
You may be referred to a physiotherapist for exercises to rebuild your Achilles tendon and leg muscle strength.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Your doctor will usually diagnose an Achilles tendon problem through a medical history and physical examination. During the physical examination, he or she will:
To help identify a tear or rupture, your doctor will:
Further tests may be done to clarify a diagnosis or to prepare for surgery. These tests include:
Treatment for Achilles tendinopathy includes not only rest to allow the tendon to heal but also ways to increase strength and flexibility to prevent further injury. Treatment for an Achilles tendon rupture includes surgery or a cast, splint, brace, walking boot, or other device that will keep your lower leg from moving (immobilization). Early treatment usually results in better healing.
To treat Achilles tendinopathy, your doctor will advise you to:
Your doctor may suggest that you wear a night brace to keep your foot flexed, if your Achilles tendon shortens and stiffens while you sleep.
If you continue to have pain or stiffness in the ankle area, your doctor may prescribe a walking boot or other device for 4 to 6 weeks to keep your lower leg and foot from moving and allow the tendon to heal.
If you still have Achilles tendon pain after more than 6 months of consistent treatment and rest, you might need to consider surgery.
Treatment for an Achilles tendon rupture includes:
Do not smoke or use other tobacco products. Smoking slows healing because it decreases blood supply and delays tissue repair.
If you have an Achilles tendon rupture, your decision about whether to have surgery will depend in part on your:
Most Achilles tendon injuries occur during sports and can be prevented. If you had an Achilles tendon problem in the past, it is especially important to try to prevent another injury by:
If you have Achilles tendinopathy, follow these steps to rest, heal, and strengthen your Achilles tendon and prevent further injury:
Your doctor may suggest you wear a night brace to keep your foot flexed, if your Achilles tendon shortens and stiffens while you sleep.
Whether you treat an Achilles tendon rupture with surgery or use a cast, splint, brace, walking boot, or other device to keep your lower leg from moving (immobilizing your leg), after treatment it's important to follow the rehabilitation program prescribed by your doctor and physiotherapist. This program helps your tendon heal and prevents further injury.
Surgery usually is not needed to treat Achilles tendinopathy. But in rare cases, someone might consider surgery when rubbing between the tendon and the tissue covering the tendon (tendon sheath) causes the sheath to become thick and fibrous. Surgery can be done to remove the fibrous tissue and repair any small tendon tears. This may also help prevent an Achilles tendon rupture.
Surgery is often used to reattach the ends of a ruptured Achilles tendon. It provides a better chance of preventing the tendon from rupturing again compared to using a cast, splint, brace, walking boot, or other device that will keep your lower leg from moving (immobilization).3
The results of surgery for an Achilles tendon rupture are best when you have the surgery soon after your injury. Recovering from surgery may take months, and it requires a rehabilitation (rehab) program to help heal and strengthen the tendon.
Surgery for an Achilles tendon rupture can be open or percutaneous.
The differences in age and activity levels of participants can make it difficult to determine if Achilles tendon surgery is effective. The success of your surgery can depend on your surgeon's experience, the type of surgical procedure used, the extent of tendon damage, how soon after rupture the surgery is done, how soon your rehab program starts after surgery, and how well you follow your rehab program.
Talk to your surgeon about his or her surgical experience and success rate with the technique that would best treat your condition.
Common physiotherapy treatments for Achilles tendinopathy include:
If other treatment does not reduce your Achilles tendinopathy pain, your doctor may recommend using a cast, brace, walking boot, splint, or other device for 4 to 6 weeks to prevent your lower leg and foot from moving and to allow the tendon to heal. This is then followed by physiotherapy and modification of activities.
A cast or similar device can be used to immobilize a ruptured Achilles tendon, giving it time to heal on its own. A cast or similar device prevents the lower leg and ankle from moving. Treatment with this type of device may take as long as 6 months to completely heal a tendon. This is usually followed by a rehabilitation (rehab) program that helps you regain strength and flexibility in the tendon and leg. The rehab program may include physiotherapy as noted above.
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- Beeharry D, et al. (2005). Familial hypercholesterolaemia commonly presents with Achilles tenosynovitis. Annals of Rheumatic Disease, 65: 312–315.
- Van der Linden PD, et al. (2003). Increased risk of Achilles tendon rupture with quinolone antibacterial use, especially in elderly patients taking oral corticosteroids. Archives of Internal Medicine, 163(15): 1801–1807.
- Khan RJ, et al. (2010). Surgical interventions for treating acute Achilles tendon ruptures. Cochrane Database of Systematic Reviews (9).
Other Works Consulted
- American Academy of Orthopaedic Surgeons (2009). Diagnosis and Treatment of Acute Achilles Tendon Rupture: Guideline and Evidence Report. Available online: http://www.aaos.org/Research/guidelines/atrguideline.pdf.
- Maffulli N, Ajis A (2008). Management of chronic ruptures of the Achilles tendon. Journal of Bone and Joint Surgery, 90(6): 1348–1360.
- Reddy SS, et al. (2009). Surgical treatment for chronic disease and disorders of the Achilles tendon. Journal of the American Academy of Orthopaedic Surgeons, 17(1): 3–14.
- Srinivasan RC, et al. (2010). Injuries of the ankle region section of Orthopedic surgery. In Current Diagnosis and Treatment: Surgery, 13th ed., pp. 1044–1048. New York: McGraw-Hill.
- Stretanski MF (2008). Achilles tendinitis. In WR Frontera et al., eds., Essentials of Physical Medicine and Rehabilitation, 2nd ed., pp. 407–410. Philadelphia: Saunders Elsevier.
|Primary Medical Reviewer||Anne C. Poinier, MD - Internal Medicine|
|Specialist Medical Reviewer||David Bardana, MD, FRCSC - Orthopedic Surgery, Sports Medicine|
|Last Revised||March 14, 2011|
Last Revised: March 14, 2012
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