What is the Achilles Tendon?

The Achilles tendon is a dense fibrous band that connects the gastrocnemius and soles (calf muscles) to the calcaneus (heel bone).  The tendon allows the calf muscles to pull on the heel so we can point our toes.  This pulling motion is what allows dancers to elevate to their tiptoes.  The Achilles tendon is the strongest and largest tendon in the body, however it is vulnerable to injury when walking, running or jumping.  This is because it has a limited blood supply and is often overused taking high forces and repetitive motions.

What Causes Achilles Tendon Injuries?

The most common cause of injury is overuse.  Typically, individuals beginning a new sport or elevating the intensity of an exercise too quickly will result in injury.  High-risk sports and activities include running, dance, football, basketball, tennis and volleyball.  Injuries to the tendon do not only have to occur with vigorous activity but can also be caused by wearing high heel shoes or possessing some common foot characteristics such as flat feet (pes planus) or over pronation.

Signs and Symptoms

Often the first sign noticed is intense pain toward the back of your foot, a couple inches above the heel.  The pain is heighted during the “toeing off” portion of gait or standing on your tiptoes.  The pain is accompanied by point tenderness, swelling and stiffness.  Depending on the severity of the injury a loud popping noise can be heard. 

Most Common Injuries to the Achilles

1.  Achilles tendon strain (tear):  Strains are tears in a muscle or a tendon.  They can range from grades 1 (microtears), grade 2 (half belly tears) and grade 3 (complete rupture). 

2.  Achilles tendon rupture:  A grade 3 strain that will make a loud “pop” sound at the time of injury.  This results in loss of plantar flexion of the foot and will require surgery or long-term bracing of the ankle. 

3.  Achilles tendinitis:  Inflammation of the Achilles tendon.  Typically an acute or fresh injury to the tendon.

4.  Achilles tendinosis:  Upon evaluation there is no evidence of inflammation.  Microscopic evaluation demonstrates cells within the tendon being disorganized, degenerated and scarred.  The majority of people with heel pain will have tendinosis as opposed to tendonitis.

5.  Achilles tenosynovitis:  Instead of affecting the tendon itself the Achilles outer covering (sheath) is affected.  This causes fibrosis and scaring that can drastically restrict motion.  Tenosynovitis can occur at the same time as tendinosis. 

6.  Achilles tendinopathy:  A tendinopathy is a disease or ailment of the tendon and is a general term that can encompass either a tendinopathy or a tendinosis.

7.  Tennis leg:  Is a rupture involving the musculotendinous junction of the gastrocnemius and its tendon.  This will typically happen to individuals over 40 and is very common in tennis players while lunging for the ball.

Basic Treatment for Achilles Tendon Damage

Fortunately mild to moderate Achilles injuries can heal on their own in time.  We can however speed up this process by following “RICE”.  This is an acronym that stands for rest, ice, compression and elevation.  Anti-inflammatories can be used but consult a pharmacist or your medical doctor first because they can have unwanted side effects.  A mild heel lift and rehabilitation including stretching and strengthening exercises is extremely important in the healing process.  Consult your chiropractor, physiotherapist or massage therapist for active rehab.