Achilles Tendonitis/Tear

What is Achilles Tendonitis/Tear?

Achilles tendonitis is inflammation of the tendon connecting the calf muscles to the heel bone. A tear (partial or complete) can occur due to excessive stress or trauma.

• Common in runners and middle-aged athletes
• Leads to pain at the back of the heel or calf
• Can be acute (sudden) or chronic (gradual onset)
• May present as tendinitis (inflammation) or tendinosis (degeneration)

Overview of the Condition

Repetitive strain, abrupt increases in activity, or insufficient stretching can injure the Achilles tendon. Severe force can cause a rupture, often felt as a pop with immediate difficulty walking. Chronic cases may develop over time, leading to thickening and pain. Treatment varies based on severity, from conservative management to surgical intervention.

Symptoms

• Pain and stiffness in the Achilles tendon, especially in the morning
• Thickening of the tendon, tenderness to touch
• Sudden sharp pain and a 'pop' feeling if rupture occurs
• Swelling and bruising around the tendon
• Difficulty walking or climbing stairs
• Weakness in the calf muscle
• Limited range of motion in the ankle
• Pain that worsens with activity and improves with rest
• Crepitus (grating sensation) when moving the tendon
• Increased pain with prolonged standing or walking
• Pain that radiates up the calf or down to the heel

Causes

• Overuse from repetitive activities (running, jumping)
• Sudden increase in physical activity or intensity
• Poor footwear or lack of proper support
• Tight calf muscles or Achilles tendon
• Age-related degeneration of the tendon
• Previous history of Achilles injuries
• Inadequate warm-up before exercise
• Certain medications (e.g., fluoroquinolones) that may weaken tendons

Diagnosis

• Physical examination to assess tenderness, swelling, and range of motion
• Thompson test to check for rupture (squeezing calf muscle)
• Ultrasound or MRI for imaging to confirm diagnosis and assess severity
• X-rays to rule out bone-related issues or calcifications
• Assessment of gait and biomechanics to identify contributing factors

Treatment Options

• RICE protocol and activity modification
• Physical therapy with eccentric calf exercises
• Heel lifts or orthotics to reduce stress
• Surgery for complete tears or severe cases

Conservative Management

Mild or partial tears often improve with rest, immobilization (boot), and a structured rehab program focusing on gradual loading of the tendon.

Rehabilitation Exercises

1. Eccentric calf lowers on a step
2. Plantarflexion/dorsiflexion with resistance bands
3. Progressive weight-bearing and balance exercises
4. Stretching of the calf and Achilles tendon
5. Gradual return to sport-specific activities

When is Surgery Needed?

Complete ruptures or significant partial tears in active individuals often undergo surgical repair to restore tendon continuity and strength.

Surgical Procedures

• Primary end-to-end tendon repair
• Tendon graft augmentation if tissue quality is poor
• Protective boot or cast post-op, followed by rehab

Anatomy Overview

The Achilles is the largest tendon, connecting the gastrocnemius and soleus muscles to the calcaneus. It endures high loads during walking and running.

Affected Areas

• Mid-tendon area (common for tendinitis)
• Insertional area near the heel bone
• Surrounding paratenon, which can become inflamed

Frequently Asked Questions

QuestionAnswerHow long is recovery after an Achilles rupture?Typically 4-6 months for basic functional recovery, though return to high-level sports can take up to a year.Can I prevent Achilles tendon injuries?Proper warm-up, calf stretching, gradual training increases, and supportive footwear can reduce risk.What are the signs of a ruptured Achilles tendon?A sudden sharp pain, swelling, bruising, and difficulty walking or standing on tiptoes.Is surgery always necessary for Achilles tendonitis?No, many cases respond well to conservative treatment. Surgery is reserved for severe or chronic cases.Can I run with Achilles tendonitis?Running may exacerbate symptoms. It's best to modify activity and consult a healthcare provider.What is the difference between tendinitis and tendinosis?Tendinitis refers to inflammation of the tendon, while tendinosis indicates degeneration without inflammation.Are there any specific exercises to avoid?High-impact activities or excessive stretching of the calf should be avoided during acute phases.How can I manage pain at home?Rest, ice application, over-the-counter pain relievers, and gentle stretching can help manage symptoms.What footwear is best for Achilles tendonitis?Shoes with good arch support, cushioning, and a slight heel lift can help alleviate strain on the tendon.When should I see a doctor?If pain persists despite home care, or if you experience severe swelling, bruising, or difficulty walking.

Prevention Strategies

• Gradual progression in running or sports
• Regular calf and Achilles stretches
• Avoid sudden increases in training intensity

Related Conditions

• Haglund’s deformity
• Plantar fasciitis
• Calf muscle strains

Additional Treatments

ESWT (shockwave therapy) or PRP injections are occasionally used for chronic tendinitis to promote healing in stubborn cases.