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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 are:
Problems with the Achilles tendon may seem to happen suddenly. But usually they are the result of many tiny tears in the tendon that have happened over time.
Achilles tendinopathy is likely to occur in men older than 30. Most Achilles tendon ruptures occur in people 30 to 50 years old who are recreational athletes ("weekend warriors"). Ruptures can also happen in older adults.
Achilles tendinopathy is most often caused by overuse or repeated movements 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.
Achilles tendon 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.
Symptoms of Achilles tendinopathy 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.
Symptoms of an Achilles tendon rupture may include a sudden, sharp pain. Most people feel or hear a pop at the same time. Swelling and bruising may occur. 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.
If your symptoms are severe or don't improve with treatment, your doctor may want you to get an X-ray, ultrasound scan, or MRI.
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 help prevent more injury. Orthotic shoe devices can also help reduce stress on the tendon.
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 and ankle from moving. Exercise, either in physical therapy or in a rehab program, can help the lower leg and ankle 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.
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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 would have after a complete rupture.
Achilles tendinopathy starts with repeated small tears in the tendon. These tears may cause no obvious symptoms. Or they may cause 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 form in the tendon, and it may thicken.
Without rest and treatment of Achilles tendinopathy, you may develop long-lasting (chronic) pain.
An Achilles tendon can partially tear or completely tear (rupture). A tear usually occurs in the tendon about 1.5 in. (3.8 cm) to 2.5 in. (6.4 cm) above where it attaches 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 don't treat an Achilles rupture, you will feel weakness in your first steps when you walk. It may feel like walking in the sand. Over time, walking will become difficult.
Other conditions can affect the Achilles tendon area. These other conditions are caused by inflammation. They include:
Things that increase your risk for Achilles tendinopathy or rupture include:
Other risk factors for an Achilles tendon rupture include:
Call your doctor now if you think you have an Achilles tendon problem (at or above the back of your ankle) and:
If you 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 wait-and-see approach. It's not a good choice if you have severe pain in the Achilles tendon area. Early treatment works best.
If you think you have Achilles tendinopathy and you have mild symptoms, rest your lower leg and foot for a couple of days. If you have weakness, cramping, or constant pain in your Achilles tendon, call your doctor.
Most doctors diagnose an Achilles tendon problem through a medical history and physical exam. This includes checking for tenderness, watching how you walk and stand, and comparing the range of motion of your two legs.
Other tests may be done to clarify a diagnosis or to prepare for surgery. These tests include:
Early treatment usually results in better healing.
To treat Achilles tendinopathy:
If your Achilles tendon shortens and stiffens while you sleep, your doctor may suggest that you wear a night brace to keep your foot in a neutral position (not pointing up or down).
If you keep having pain or stiffness in the ankle area, your doctor may prescribe a walking boot or other device for 4 to 6 weeks. This keeps your lower leg and ankle from moving. It allows 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:
Don't 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. If you had an Achilles tendon problem in the past, it is especially important to try to prevent another injury. To help prevent injury, try to:
Home treatment is often used for Achilles tendinopathy as part of physical therapy or rehabilitation (rehab) after an Achilles tendon rupture.
Follow these steps to rest, heal, and strengthen your Achilles tendon and prevent further injury:
If your Achilles tendon shortens and stiffens while you sleep, your doctor may suggest that you wear a night brace to keep your foot in a neutral position.
No matter how you treat an Achilles tendon rupture, after treatment it's important to follow your rehab program. This program helps your tendon heal and helps prevent further injury.
You can use medicine to relieve pain from Achilles tendinopathy or an Achilles tendon rupture. The medicine may be prescription or nonprescription. Be safe with medicines. Read and follow all instructions on the label.
Corticosteroid injections, which sometimes are injected around tendons or into joints to reduce pain and inflammation, aren't used to treat Achilles tendinopathy. They may increase the risk of a tendon rupture.
Surgery usually isn't 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 may provide a better chance of preventing the tendon from rupturing again compared to using a cast or other device that will keep your lower leg and ankle from moving ( immobilization).footnote 1
Surgery works best when you have surgery soon after your injury. Recovering from surgery may take months. Most surgeons will wait a few days for swelling to go down, then do the surgery as soon as possible. Surgery is usually done within 4 to 6 weeks. You will also need a rehabilitation (rehab) program to help heal and strengthen the tendon.
Surgery for an Achilles tendon rupture can be done with a single large incision, which is called open surgery. Or it can be done with several small incisions. This is called percutaneous surgery.
The differences in age and activity levels of people who get surgery can make it hard to know if Achilles tendon surgery is effective. The success of your surgery can depend on:
Talk to your surgeon about his or her surgical experience. Ask about his or her success rate with the technique that would best treat your condition.
Other treatments are often used for Achilles tendinopathy or rupture. Before using other treatments, you most likely will try rest and medicine to reduce pain and swelling.
A cast or similar device can be used to prevent the lower leg and ankle from moving (immobilization). This type of treatment 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 physical therapy.
Common physical therapy treatments include:
If other treatment doesn't reduce your pain, your doctor may recommend using a cast or other device for 4 to 6 weeks. These devices can prevent your lower leg and ankle from moving and allow the tendon to heal. This is then followed by physical therapy and changes in your activities.
Medical researchers continue to study new ways to treat tendon injuries. Talk to your doctor if you are interested in experimental treatments. Some of the treatments being studied include:
Khan RJK, Smith RLC (2010). Surgical interventions for treating acute Achilles tendon ruptures. Cochrane Database of Systematic Reviews (9).
Current as of:
November 16, 2020
Author: Healthwise StaffMedical Review: Anne C. Poinier MD - Internal MedicineE. Gregory Thompson MD - Internal MedicineAdam Husney MD - Family MedicineKathleen Romito MD - Family MedicineDavid Bardana MD, FRCSC - Orthopedic Surgery, Sports Medicine
Current as of: November 16, 2020
Author: Healthwise Staff
Medical Review:Anne C. Poinier MD - Internal Medicine & E. Gregory Thompson MD - Internal Medicine & Adam Husney MD - Family Medicine & Kathleen Romito MD - Family Medicine & David Bardana MD, FRCSC - Orthopedic Surgery, Sports Medicine
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