The Achilles tendon is the largest tendon in the body. It allows you to run, jump and walk. It connects the heel bone to the calf muscle. This tendon is tough and strong, but it’s not immune to injury. The most common cause of injury to this structure is overexertion while playing recreational sports, however, it can happen to anyone.
Injury to the Achilles tendon takes two major forms: tendonitis and rupture. Tendonitis is an inflammation of the Achilles. You may notice pain in your heel area and also down the back of your leg. Tendonitis of the Achilles comes in two forms:
In this form, small tears occur in the middle area of the Achilles. The tendon breaks down, causing the symptoms of pain and swelling. This is most often seen in younger, very active adults.
This is a tear in the tendon where it meets the heel bone. It can cause heel pain and swelling and can occur even in people who are sedentary.
Rupture is a tearing of the Achilles tendon. It can be partial or total. A total rupture sign is a popping sound coming from the heel area, accompanied by sharp pain. This requires immediate medical attention. A complete rupture may require surgery to heal properly. Tendonitis can typically be treated by casting, ice application, anti-inflammatory medications and physical therapy.
Sometimes Achilles tendon injuries happen from simple overuse. Other causes include falling from a high place, stepping in a hole and overexertion in sports, especially those that require jumping.
Achilles tendon rupture occurs most often in younger men. Obesity may increase your risk. Steroid injections can sometimes weaken the tendon. Some antibiotics, such as Cipro, may also cause rupture of this tendon in some cases.
This next section will discuss specific symptoms of Achilles injury.
1. Stiffness
One of the hallmark signs of Achilles tendon injury is stiffness. When this tendon is injured, you will not have the normal flexibility of the joint. You will notice that the joint feels stiff and not fluid, as it should. This is because the Achilles is necessary for normal movement and feel of the foot. The stiff discomfort will likely be worse in the morning or after long period of sitting. This is because the tendon has tightened up during this time. The tendon injury causes it to contract abnormally, which you feel as a painful stiffness. This stiffness may also be felt at the back of the calf.
The degree of stiffness often depends upon the degree of tendon injury. Your doctor may instruct you to gently stretch the area to relieve some of the stiffness. Special exercises may also be recommended to help strengthen the area and relieve pain and stiffness. Your doctor may also recommend orthotics, or special foot gear and devices. Sometimes complete rest is necessary. Anti-inflammatory medications such as ibuprofen may also help with stiffness and pain. In other cases, physical therapy can help with the stiffness you feel. Your doctor may also recommend more than one type of therapy in order to give you the best relief.
2. Tenderness
The Achilles tendon stretches from the bottom of the heel up to the calf muscle attachment roughly a third of the way up the back of your calf. You may notice tenderness anywhere along this area. The tendon may be enlarged. Avoid putting any pressure on the area, especially along the sides of the tendon area. Doing so will likely result in even more pain and tenderness. The tenderness will likely be worse in the morning and after periods of exertion. Your doctor will instruct you regarding your activity level so that tenderness can be kept to a minimum. Anti-inflammatory medications, such as ibuprofen, may ease the tenderness and help you feel more comfortable.
3. Swelling
Swelling may occur anywhere along the tendon location area. You may also notice bruising, especially in the heel area. The tendon swells in reaction to the inflammation in the area. Medications such as ibuprofen may help reduce both swelling and pain. Sometimes the swelling is caused by a bone spur in the heel area. Bone spurs can cause damage to the Achilles tendon, resulting in inflammation, pain and swelling. Your doctor may recommend that you restrict your activities while the area is swollen. Other treatments include the application of ice, elevation of the foot and the use of compression bandages such as Ace.
4. A Snap or Popping Noise
This is a serious symptom that indicates a possible complete rupture of the tendon. If you suddenly hear a popping noise coming from the heel area, followed by sharp pain in the heel area or calf area, you may have incurred a rupture of the tendon. If the rupture is only partial, you may still have some movement ability in your foot. However, a complete rupture will result in the inability to point your foot downwards or stand on your toes. You may not even be able to walk at all. A partial rupture may only produce pain and swelling. It may or may not require surgery. A total rupture often requires surgical repair and rehabilitative therapy.
5. Irritable
An Achilles tendon injury will be quite irritable. The area will be sensitive to the slightest touch while it heals. This is even more true if your injury required surgery to repair it. Make sure you follow your doctor’s instructions exactly in order to avoid unnecessary irritation to a healing Achilles tendon. Your doctor may recommend a special walking boot or even crutches to avoid irritating pressure on the area. Special exercises may also help to ease the irritable symptoms. Anti-inflammatory medication, such as ibuprofen, will reduce irritation and pain. Your doctor may also tell you to ice and elevate the affected foot.
6. Pain in Back of Foot
Pain in the back of the foot by the heel area is a common symptom of Achilles tendon injury. You may also notice a dull ache in the back of the calf area. You will likely notice that the pain is worse while you walk, especially as you push off from the heel area to take a step. Sometimes people confuse an Achilles tendon injury with a sprained ankle, but a sprained ankle generally heals within a few days. In contrast, pain from an Achilles injury will persist and may worsen over time. If left untreated, walking may become so painful that it’s nearly impossible. Any pain in the back of the foot area that doesn’t go away within a few days is suspect for an Achilles tendon injury and needs to be medically evaluated and treated.
7. Difficulty Flexing Foot
If you cannot flex your foot or point your toes, you likely have a complete rupture of the Achilles tendon. The tendon stretches from the heel to the calf muscle, which enables you to make flexing motions with your foot. If the tendon has torn completely, then no flexion is possible, because the tendon is no longer connecting to the calf muscle. Intense pain almost always occurs with this type of injury. Surgery to repair and reattach the tendon is the only treatment option for a totally ruptured Achilles. Physical therapy and rehabilitative services will also be required in order to restore full function.
