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Achilles Tendon Injury: Understanding, Causes, and Treatment

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Man running showing the rear of his foot and the Achilles tendon wearing running shoes

Updated:

March 31, 2024

The Achilles tendon, the largest tendon in the body, plays a crucial role in our mobility. It connects your heel bone to the large muscles in your calf, enabling you to extend your foot. This tendon is vital for pushing off the ground when walking, running, and engaging in sports. However, due to its importance and frequent use, the Achilles tendon is prone to damage or injury.

What is an Achilles Injury?

achilles tendon injury

An Achilles injury, or Achilles tendonitis, is an injury due to the overuse, sprain, or complete achilles rupture of the Achilles tendon. This tendon attaches muscles at either end of the bone, and injuries to the Achilles tendon can vary in severity from a dull ache to severe pain.

They also have a covering or “sheath” that can get irritated, tear or form a “ganglion” (fluid-filled sack). Tendonitis can be a simple overuse syndrome, injury, or secondary problem from other foot and ankle conditions. All tendonitis injuries, especially ones where a tear, achilles tendon rupture or associated fracture is suspected, need to be evaluated by a physician with standard X-rays taken or other advanced testing.

Most people with a damaged or injured Achilles tendon report the feeling of having been kicked in the calf. Some state that they heard a loud ‘pop’ when playing sports and felt major pain near the back of the heel. Also common is the inability to bend the foot downward, or movement of the foot downward when squeezing their calf muscle and the inability “push off” the injured lower leg when walking.

This condition is associated with other foot and ankle conditions such as:

  • Ankle Arthritis
  • Plantar Fasciitis
  • Stress Fractures
  • Ankle Sprain
  • Shin Splints
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Understanding Achilles Tendon Injury

Achilles tendon injuries can range from mild strains to severe ruptures. They are commonly seen in athletes and individuals who engage in high-impact activities. However, they can also occur in everyday situations, especially if the tendon has been weakened by overuse or age.

Causes of Achilles Pain

Achilles pain can be caused by a variety of factors:

  • Injury: This often occurs when you increase your activity too quickly over a short period of time.
  • Over-use: Constant strain on the Achilles tendon can lead to injury.
  • Improper stretching prior to exertion: Not preparing your muscles and tendons before physical activity can lead to injury.
  • Incorrect form during physical activity: Poor posture or technique can put unnecessary strain on the Achilles tendon.
  • Pre-existing foot issues: Conditions like flat feet or high arches can put extra stress on the Achilles tendon.
  • Chronic high heel wearers: Wearing high heels frequently can shorten and strain the Achilles tendon.

Symptoms of Achilles Tendon Injury

The most prominent symptom of an Achilles injury is pain, which is most noticeable when you try to move the foot down against resistance. The involved tendon may also swell. The pain may come and go or gradually get worse over time.

More severe injuries can lead to a possible rupture of the tendon, often indicated by a pop or a snap heard while playing sports. This requires immediate attention.

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How We Treat Achilles Tendon Injuries

Each patient is different and conservative treatment vs. surgical correction both differ for the particular type of problem, age, and lifestyle. The right treatment must also meet the patient’s expectations in regard to the resolution of their problem(s) and future functionality.

If conservative treatment fails, the option to not have surgery is as important as the surgery chosen by your surgeon. Of course, surgical training is very important, and continuing medical education on the latest medical advancements is important as well, but it’s the careful planning before and after surgical treatment that produces the best outcome.

Conservative Achilles Injury Treatments

Rest

Crutches and non-weight bearing on the affected foot or ankle for 1 to 3 weeks is the best care for a severe overuse syndrome or injury like an Achilles injury, but a simple decrease in activities may be enough to relieve symptoms.

Stretching

Static stretching to the “point of discomfort” and holding those positions for 10 seconds each for 3 sets every day will help speed recovery and recurrence.

Medication

Anti-inflammatory medication can help with the chronic pain but are not much help with the acute pain.

Support

Casting or a removable CAM walker is the best “aggressive” conservative care for severe tendonitis or injuries. Temporary arch supports or supportive athletic shoes will support the foot and ankle in a more neutral position.

This will put less strain on the injured area and decrease the incidence of re-injury when returning to activities or exercise. Custom molded orthotics are the best solution for immediate and long-term treatment.

Physical Therapy

Examples of physical therapy that can help Achilles injuries include massage, cold therapy, contrast baths, stretching, ultrasound, and electric stimulation.

Surgical Treatment for Achilles Injury

No surgery is usually required for this condition, but partial tears, “attenuations” or complete ruptures may necessitate surgical reattachment. The procedure is a simple suturing of the tendons ends unless a graft or reattachment to the heel bone with a “bone anchor” device is needed.

The postoperative period is extended to 6-8 weeks non-weight bearing, with physical therapy thereafter.

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Insurance Coverage for Achilles Tendonitis Injury

When facing an Achilles tendonitis rupture, navigating insurance coverage can be as crucial as the medical treatment itself. Coverage varies significantly between different insurance providers and plans, making it essential for patients to understand their policy's specifics.

Typically, most insurance plans cover the necessary diagnostic tests, conservative treatments, and surgical interventions for ruptured Achilles tendon or achilles tendinitis, acknowledging the need for comprehensive care.

Before getting treatment for your Achilles tendon injury, it's a good idea to check with your insurance provider. Ask about your coverage and any costs you might have to pay.

At Modern Foot & Ankle, we're here to help. We're proud to be in-network with all major insurance plans, which can make the process smoother and more affordable for you. Our team can assist you in understanding your coverage and guide you through the process.

Why Choose Us for Achilles Injuries

Choosing the right care for Achilles tendon injuries can be a daunting task, but at Modern Foot & Ankle, we provide unparalleled expertise and a personalized approach to ensure the best outcomes for our patients. Here's why we stand out:

Expertise in Complex Cases

Our specialists possess extensive experience in diagnosing and treating a wide range of Achilles tendon disorders, including Achilles tendon ruptures and tendinitis. We stay abreast of the latest advancements in treatment to offer you the best possible care.

Comprehensive Treatment Options

From conservative approaches like physical therapy and custom orthotics to advanced surgical techniques for Achilles tendon tears and ruptures, we offer a full spectrum of treatments tailored to your specific needs.

State-of-the-Art Facilities

Our clinics are equipped with the latest diagnostic and treatment technologies, enabling us to provide accurate diagnoses and effective treatments for Achilles tendon injuries and other foot and ankle conditions.

Patient-Centered Care

We believe in a holistic approach to treatment, focusing not just on the injury but on the patient's overall health and lifestyle, to ensure a full and sustainable recovery.

Innovative Physical Therapy Programs

Our rehabilitation programs are designed to support recovery from Achilles tendon surgeries and injuries, emphasizing Achilles tendon injury prevention and the strengthening of the tight calf muscles and tendon fibers.

Education and Prevention:

We are committed to educating our patients on how to prevent Achilles tendinosis, tendinitis, and other Achilles tendon disorders, offering resources and guidance to maintain healthy Achilles tendons and calf muscles.

Insurance and Financial Guidance:

Navigating insurance can be confusing, which is why we provide comprehensive assistance to ensure you understand your coverage and out-of-pocket costs for treating Achilles tendon ruptures and other conditions.

Dedicated Follow-Up Care

Our commitment to your recovery extends beyond your treatment. We offer dedicated follow-up care to monitor your progress and ensure a return to full functionality and an active lifestyle.

In Summary

  1. Achilles tendon injuries can cause significant pain and discomfort if left untreated.
  2. The treatment and management of Achilles tendon injuries, including ruptures, tears, and tendonitis, require a comprehensive approach that spans accurate diagnosis, effective treatment options, and thorough rehabilitation.
  3. Our clinics offer comprehensive care for patients with Achilles tendon injuries, including conservative treatments and surgical intervention when necessary.
  4. Seeking care as soon as possible increases the chances of successful non-surgical treatment and prevents further complications.
  5. Trust the expertise of our dedicated team of podiatrists at our clinic to provide personalized, effective care for your Achilles tendon injury needs.

The information on our website is intended for general informational and educational purposes only and should not be used as a substitute for professional medical advice. For any health-related concerns, we strongly recommend consulting with a healthcare professional. Please note that any reliance on the information found on our site is solely at your own risk. For more details, please see our Medical Disclaimer.

FAQs

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How do you prepare for Achilles tendon surgery?

Prior to an Achilles tendon surgery, it is very important to remain avoid bearing weight and in position the foot in a splint with the foot pointing downward. Other things to consider are shaving and washing the area prior to surgery. It is also critical to remove obstacles at home and make sure the correct post-operative assistive devices are available (crutches, walker, knee scooter, wheelchair) and you have a plan to easily access the bathroom, shower, and prepare food.

Do they put you to sleep for Achilles surgery?

Yes, they put you to sleep during Achilles surgery. General anesthesia is the preferred method for Achilles surgery since a thigh tourniquet is used during the surgery and some operating times can be lengthy. A spinal or popliteal block with sedation is possible, but will depend upon the surgeon’s preferences and patient medical history.

How do I strengthen my Achilles tendon after surgery?

The Achilles tendon does not require strengthening immediately after surgery and is best to let it heal for 6 to 8 weeks. The calf muscle (Gastrocnemius-Soleus complex) can be strengthened with simple walking, but physical therapy and proper exercises are recommended.

When can I return to work after Achilles tendon surgery?

Returning to work after an Achilles tendon surgery depends on the type of work and how much stress is placed on the lower extremity. If a patient can use crutches and assistive devices like a knee scooter or wheelchair, they can go back to work as soon as a week or two. It takes an Achilles tendon 6 to 8 weeks to reach a particular ‘tensile strength’ to warrant walking with full weight bearing. Keep in mind—even a sit-down job still requires the patient to drive to work, walk around during breaks, and move to the parking lot and bathroom.

How long is recovery from Achilles tendon surgery?

Recovery for an Achilles tendon surgery is a relative term that depends on each patient. Age, genetics, weight, and other medical conditions contribute to the recovery of this surgery as well. Non-weight bearing is between 6 to 8 weeks, and then partial to full weight-bearing can occur after 6-8 weeks, but should include some physical therapy, stretching and early activities in a walking cast or cam walker. Pain, swelling, or weakness are indicators to guide the surgeon and patient through the recovery period. As these symptoms lessen with each increase in activity, then more activities like exercise can be introduced.

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