Achilles Tendon: Tendinitis and Tears

Why is the Achilles tendon so important?
The Achilles tendon is the strongest and largest tendon in the body. It is a tendinous structure (attaches muscle to bone) that forms from a combin-ation of the gastrocnemius-soleus muscles located in the calf. The tendon attaches to the heel bone (calcaneus) and causes the foot to push off (plantar flex) when the calf muscles tighten. The tendon is necessary for normal walking, running, and jumping. Athletic and traumatic injuries to the Achilles tendon are common and can be disabling.

What is Achilles tendinitis?
Achilles tendinitis is an inflammation (swelling) of the tendon, which usually occurs as a result of overuse injury. Basketball players are the most susceptible to Achilles tendinitis because of the frequent jumping. Any activity requiring a constant pushing off the foot, such as running or dancing, may result in swelling of the tendon.

Symptoms and treatment for Achilles tendinitis
People with Achilles tendinitis may experience pain during and after exercising. Running and jumping activities become painful and difficult. Symptoms include stiffness and pain in the back of the ankle when pushing off the ball of the foot. For patients with chronic tendinitis (longer than six weeks), x-rays may reveal calcification (hardening of the tissue) in the tendon. Chronic tendinitis can result in a breakdown of the tendon, or tendinosis, which weakens the tendon and may cause a rupture.

The recommended treatment for Achilles tendinitis consists of icing, gentle stretching, and modifying or limiting activity. Nonsteroidal anti-inflammatory medications (NSAIDs), such as ibuprofen or aspirin, can reduce pain and swelling. Physical therapy and the use of an orthotic (heel lift) can also be helpful. For chronic cases where tendinosis is evident and other methods of treatment have failed, surgery may be recommended to remove and repair the damaged tissue.

What is an Achilles tendon rupture?
Achilles tendon rupture is a severe and disabling injury. A rupture usually takes place a couple of inches above the joining of the tendon and the heel bone. This typically occurs when someone contracts, or tightens, the calf muscle and suddenly pushes off the foot, such as in basketball or racquet sports. The injured person experiences pain, swelling, and an inability to stand on their tiptoes.

Symptoms and treatments for an Achilles tendon rupture
Achilles tendon ruptures usually occur in middle aged men as a result of overused or unused muscles. An injured person experiences extreme difficulty with pushing off the foot and even walking. Physical exams reveal swelling, a gap in the tendon, and an inability to stand tiptoed (plantar flexion). X-rays may be used to confirm a diagnosis. Magnetic resonance imaging (MRI) or ultrasounds can also confirm an Achilles tendon tear; however, they are not always necessary.

Surgery is usually recommended for treatment of Achilles tendon ruptures in active, healthy patients. For people with low levels of activity, casting can be used. Resumption of full athletic activity usually takes four to six months, or longer, after injury in the surgically treated patient. Surgically repaired tendons heal stronger with less chance of rerupture.

Richard Johnston III, MD
Atlanta, Georgia