Topic Overview
What is the Achilles tendon?
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.
What are common Achilles tendon problems?
The
two main problems are:
- Achilles tendinopathy. This includes one of two conditions:
- Tendinitis. This actually means "inflammation of the tendon." But inflammation is
rarely the cause of tendon pain.
- Tendinosis. This refers to tiny
tears (microtears) in the tissue in and around the tendon. These tears are caused by overuse. In
most cases, Achilles tendon pain is the result of tendinosis, not tendinitis.
Some experts now use the term tendinopathy to include both inflammation and
microtears. But many doctors may still use the term tendinitis to describe a
tendon injury.
- Achilles tendon tear or rupture. An Achilles tendon also can partially tear or
completely tear (rupture). A partial tear may cause mild or no symptoms. But a
complete rupture causes pain and sudden loss of strength and movement.
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.
What causes Achilles tendon problems?
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.
What are the symptoms?
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.
How are Achilles tendon problems diagnosed?
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.
How are they treated?
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. 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 from moving. Exercise, either in physical therapy 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
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Cause
Achilles tendinopathy is most often caused by:
- Overuse or repeated movements during sports,
work, or other activities. In sports, a change in how long, intensely, or often
you exercise can cause microtears in
the tendon. These tears are unable to heal quickly and will eventually cause pain.
A change in your environment, such as going from a flat
surface to a hill or from a paved road to a dirt road, can also cause these tears.
- Injury from repeated push-offs or a stop-and-go motion. These injuries are common in
such activities as running, basketball, tennis, or ballet dancing.
- Poor conditioning or warm-up. This can happen when you start a new activity or
haven't stretched before and after an activity.
- Shoes with poor
arch support or rigid heels that don't cushion the heel.
Achilles tendon rupture is most often caused
by:
- Sudden, forceful motion that stresses the calf
muscle. This can happen during an intense athletic activity or even during simple
running or jumping, especially in middle-aged adults. A
rupture most often occurs in sports such as
basketball, racquet sports (including tennis), soccer, and softball.
- Overstretching the tendon during any activity
when the tendon is already damaged because of Achilles tendinopathy or another
condition.
- Previous
corticosteroid injections. (In the past, these were a common
treatment for overuse tendon injury.) Corticosteroids can weaken or break down
tendon tissue, making it more likely to rupture.
Symptoms
Symptoms of
Achilles tendinopathy may include:
- Pain in the back of the heel, in the
Achilles tendon area. Pain may be mild or severe. Swelling may
occur.
- Tenderness in the Achilles tendon area. Tenderness may be
more noticeable in the morning.
- Stiffness that goes away as the
tendon warms up with use.
- Decreased strength and movement, or a
feeling of sluggishness in the leg.
Symptoms of an
Achilles tendon rupture may include:
- A sudden, sharp pain that feels like a direct
hit to the Achilles tendon. There may be a pop when the rupture occurs. This
may be followed by swelling and bruising.
- Heel pain. (It may be
severe.)
- Not being able to go on tiptoe with the hurt leg.
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.
What Happens
Achilles tendinopathy
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.
Achilles tendon tear or rupture
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 Achilles tendon problems
Other conditions
can affect the Achilles tendon area alone or along with tendinosis. These other
conditions are caused by inflammation. They include:
What Increases Your Risk
Things that increase your
risk for
Achilles tendinopathy or
rupture include:
- Sports and physical activity. Overuse and
repeated movements can cause injury and weaken the Achilles tendon. Playing
sports increases the risk of an injury. Activities at work
(such as in construction) and at home (such as gardening) may also increase
your risk.
- Sports training errors. Not warming up before and
after running or other activities or suddenly changing your training program
can increase your risk for injury. Increasing your distance, running uphill
more often, or changing your ground surfaces too quickly can increase your risk.
- Age. As you age, the blood supply to the Achilles
tendon area decreases. Most cases of Achilles tendinopathy or rupture occur in
people older than 30.
- Weight. If you are very heavy, you have a greater
risk.
- Being male. Men are more likely than women to have
an Achilles tendon injury.
- High cholesterol. If
high cholesterol runs in your family, you have a
higher risk of Achilles tendon pain and problems.1
Other risk factors for an
Achilles tendon rupture include:
- A previous injury or rupture to the Achilles
tendon.
- Corticosteroid injections in the
Achilles tendon. They can weaken the tendon.
- Using quinolone
antibiotics, especially if you are older than 60 and/or are taking
corticosteroids by mouth.2 Quinolones include
ciprofloxacin and ofloxacin.
- Having
osteoarthritis,
gout, or
rheumatoid arthritis.
- Having received
dialysis or having had a kidney
transplant.2
When To Call a Doctor
Call your doctor right away if you think you have an
Achilles tendon problem (at or above the back of your ankle) and:
- The back of your heel and ankle are very
painful.
- You felt a sharp pain like a direct hit to the Achilles
tendon.
- You heard a pop in your Achilles tendon when
injured.
- You aren't able to walk comfortably.
- Your
Achilles tendon area has begun to swell.
- You have signs of damage
to the nerves or blood vessels. Signs include numbness, tingling, a pins-and-needles
feeling in your foot, and pale or bluish skin.
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
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 a good idea 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.
If you think you have
Achilles tendinopathy and you have mild symptoms, rest your lower leg and foot
for a couple of days. Avoid any hard activity. Use ice and pain-relieving
medicines to reduce the pain and swelling. Follow the other steps in Home Treatment. If you have weakness, cramping, or
constant pain in your Achilles tendon, call your doctor.
Who to see
Health professionals who can diagnosis and treat an
Achilles tendon problem include:
You may be referred to a
physical therapist for exercises to rebuild strength in your
Achilles tendon and leg muscles.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
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:
- Ultrasound. It may be used to
check whether there is a rupture of the tendon or signs of
tendinopathy.
- X-rays, to check the heel
bone.
- MRI scan to check the tendon for signs of tendinopathy or a tendon rupture. An MRI is also used to evaluate the heel bone.
Treatment Overview
Early treatment usually results in better healing.
Achilles tendinopathy
To treat
Achilles tendinopathy:
- Use home treatment. This includes resting your lower leg and foot, stretching the area, wearing cushioned shoes or other orthotics, and switching sports or modifying how you do sports that may have caused the problem.
- Reduce pain by using ice or taking
over-the-counter pain relievers, such as
acetaminophen or
nonsteroidal anti-inflammatory drugs (NSAIDs), as
directed.
- Follow any
physical therapy that your doctor has
prescribed. This may include stretching and strengthening exercises, massage, heat, or
ultrasound.
If your Achilles tendon shortens and
stiffens while you sleep, your doctor may suggest that you wear a
night brace to keep your foot flexed.
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 foot 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.
Achilles tendon rupture
Treatment for an Achilles
tendon rupture includes:
- Surgery followed by
rehabilitation (rehab). This is the most common treatment for younger adults.
- Immobilizing your leg, followed by
rehab. This prevents movement of the lower
leg and ankle. It allows the ends of the Achilles tendon to reattach and heal.
What to think about
If you treat an Achilles rupture with:
- Surgery followed by a rehab program,
you will likely regain full movement and function.
- A cast or other device that keeps your lower leg from moving
(immobilization), the tendon will most likely heal. But it may not be as strong as
it was before the injury. It may be more likely to rupture again. Exercising, in
physical therapy or in a rehab program, will help restore flexibility
and strength in the lower leg.
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:
- Age. If you are an older adult who doesn't do
activities that may cause another rupture and who doesn't want the added
risk of surgery, you may choose to use a cast or similar
device.
- Medical condition. If you have another medical
condition—such as
diabetes or heart or lung disease—that raises the
risks associated with surgery, you may choose to use a cast or similar
device.
- Time of injury. Surgery is generally recommended if the rupture
is more than 2 weeks old.
Achilles Tendon Rupture: Should I Have Surgery?
Prevention
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. Make sure to:
- Warm up and stretch. Before any sport or
intense activity, gradually warm up your body by doing 5 to 10 minutes of
walking or biking, and then do stretching exercises.
Calf and plantar fascia stretches will stretch the Achilles tendon area. More
general stretches target other muscles, such as the hamstrings and
groin.
- Cool down and do more stretching. After intense
activity, gradually cool down with about 5 minutes of easy jogging, walking, or
biking, and 5 minutes of stretches.
- Avoid any sport or intense
activity that you are not in condition to do.
- Wear shoes that
cushion your heel during sports or any strenuous activity.
- Wear
heel pads or other
orthotics that are designed to reduce stress on the
Achilles tendon.
Home Treatment
Home treatment is often used for
Achilles tendinopathy and in
physical therapy or rehabilitation after an Achilles
tendon
rupture.
Achilles tendinopathy
Follow these steps to rest,
heal, and strengthen your Achilles tendon and prevent further injury:
- Rest your Achilles tendon. Avoid all
activities that strain the tendon, such as stair climbing or running. Try
other activities, such as swimming, while
you give your tendon the days, weeks, or months it needs to heal. Your doctor will tell you what you can and cannot do.
- Reduce pain by icing
your Achilles tendon and taking nonprescription pain relievers such as
acetaminophen or
nonsteroidal anti-inflammatory drugs (NSAIDs) as
directed.
- Follow your
physical therapy program if one has been prescribed
for you. Do gentle stretching and strengthening exercises. Focus on
calf stretches.
- Don't smoke or use other tobacco products.
Smoking slows healing, because it decreases blood supply and delays tissue
repair.
- Wear footwear that protects the tendon while it heals.
- Quality athletic shoes that support your
arches and cushion your heels can make a big difference in your comfort
and healing. If needed, talk to your physical therapist or
podiatrist about heel pads or
orthotics.
- A bandage that keeps your foot
flexed can restrict the motion of the Achilles tendon.
- A silicone
sleeve or pad can distribute pressure on the Achilles tendon.
If your Achilles tendon shortens and
stiffens while you sleep, your doctor may suggest that you wear a
night brace to keep your foot flexed.
Achilles tendon rupture
No matter how you treat an Achilles tendon rupture, after treatment it's important to follow your
rehabilitation program. This program helps your tendon heal and
prevents further injury.
Medications
You can use medicine to relieve pain from
Achilles tendinopathy or an
Achilles tendon rupture. The medicine may be prescription or
nonprescription.
- Acetaminophen (such as Tylenol) can relieve pain.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are also often used to treat pain. But most tendon problems don't
involve inflammation, so NSAIDs usually aren't needed. These drugs include
ibuprofen (such as Advil and Motrin) and aspirin. Do not give aspirin to anyone younger
than 20, because of the risk of
Reye syndrome.
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
Achilles tendinopathy
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.
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 from moving
(immobilization).3
Surgery works best when you
have surgery soon after your injury. Recovering from surgery may take
months. You will also need a
rehabilitation (rehab) program to help heal and strengthen the
tendon.
Surgery choices
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.
What to think about
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:
- Your
surgeon's experience.
- The type of surgery you have.
- How damaged the tendon is.
- How soon after rupture the surgery is done.
- How soon you start your
rehab program after surgery.
- How
well you follow your rehab program.
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.
- Achilles Tendon Rupture: Should I Have Surgery?
Other Treatment
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.
Achilles tendinopathy
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 foot from moving and allow the tendon to heal. This is then followed
by physical therapy and changes in your activities.
Achilles tendon rupture
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
rehab program that helps you regain strength
and flexibility in the tendon and leg. The rehab program may include
physical therapy.
Other Places To Get Help
Organizations
| American Academy of Orthopaedic Surgeons
(AAOS) |
| 6300 North River Road |
| Rosemont, IL 60018-4262 |
| Phone: |
1-800-346-AAOS (1-800-346-2267)
(847) 823-7186 |
| Fax: |
(847) 823-8125 |
| Email: |
orthoinfo@aaos.org |
| Web Address: |
www.orthoinfo.aaos.org |
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The American Academy of Orthopaedic Surgeons (AAOS)
provides information and education to raise the public's awareness of
musculoskeletal conditions, with an emphasis on preventive measures. The AAOS
website contains information on orthopedic conditions and treatments, injury
prevention, and wellness and exercise.
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| American College of Foot and Ankle Surgeons
(ACFAS) |
| 8725 West Higgins Road |
| Suite 555 |
| Chicago, IL 60631-2724 |
| Phone: |
1-800-421-2237
(773) 693-9300 |
| Fax: |
(773) 693-9304 |
| Email: |
info@acfas.org |
| Web Address: |
www.foothealthfacts.org |
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|
The American College of Foot and Ankle Surgeons provides
information on surgery and shoe selection as well as the care and treatment of
heel, toe, ankle, nerve, tendon, nail, and skin conditions; sports injuries;
diabetic foot problems; arthritis; and resources in your local area. Some
information is available in Spanish.
|
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| American Podiatric Medical
Association |
| 9312 Old Georgetown Road |
| Bethesda, MD 20814-1621 |
| Phone: |
1-800-FOOTCARE (1-800-366-8227)
(301) 581-9200 |
| Fax: |
(301) 530-2752 |
| Email: |
info@apma.org |
| Web Address: |
www.apma.org |
| |
|
The American Podiatric Medical Association (APMA)
provides information about foot and ankle injuries, sports-related foot
concerns, surgical and nonsurgical treatment of foot problems, special medical
issues such as diabetes, and resources in your local area. Some information is
available in Spanish.
|
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| National Institute of Arthritis and Musculoskeletal and
Skin Diseases (NIAMS), National Institutes of Health |
| 1 AMS Circle |
| Bethesda, MD 20892-3675 |
| Phone: |
1-877-22-NIAMS (1-877-226-4267) toll-free |
| Phone: |
(301) 495-4484 |
| Fax: |
(301) 718-6366 |
| TDD: |
(301) 565-2966 |
| Email: |
niamsinfo@mail.nih.gov |
| Web Address: |
www.niams.nih.gov |
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The National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS) is a governmental institute that serves the public
and health professionals by providing information, locating other information
sources, and participating in a national federal database of health
information. NIAMS supports research into the causes, treatment, and prevention
of arthritis and musculoskeletal and skin diseases and supports the training of
scientists to carry out this research.
The NIAMS website provides
health information referrals to the NIAMS Clearinghouse, which has information
packages about diseases.
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References
Citations
- 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.
Credits
| By |
Healthwise Staff |
| Primary Medical Reviewer |
Anne C. Poinier, MD - Internal Medicine |
| Specialist Medical Reviewer |
David Bardana, MD, FRCSC - Orthopedic Surgery, Sports Medicine |
| Last Revised |
March 12, 2012 |
