Orthopaedic Conditons & Treatments

Achilles Tendon Injury, Tendonitis, Symptoms and Causes

An Achilles tendon injury is an injury that happens to the largest tendon in the human body and is usually caused by an injury, overuse or a mechanical abnormality in the foot or ankle. The Achilles tendon is the fibrous tissue that connects the two large muscles in the back of your calf to your heel bone. These muscles (the gastrocnemius and the soleus) create the power needed to push off with your foot or rise up on your toes.  

The name of the tendon comes from the legendary Greek god Achilles, a fearless warrior who was killed by an arrow that struck his heel, the only vulnerable point in his body. Hence, "Achilles' heel" became synonymous with a person's weakness.

Although your Achilles tendon can withstand forces of 1,000 pounds or more, it is the most frequently injured tendon by professional athletes and weekend athletes alike, according to the American Academy of Orthopaedic Surgeons  (AAOS). An Achilles tendon injury can range from a mild case of Achilles tendonitis (inflammation and swelling) to a more serious rupture or tear in the tendon that requires Achilles tendon repair surgery. The AAOS reports that an acute Achilles tendon rupture affects an estimated 5.5 to 9.9 of every 100,000 people in North America each year.

Types of Achilles Tendonitis
Depending on which part of your Achilles tendon is inflamed, you could be experiencing:

  • Noninsertional Achilles tendonitis — Fibers in the middle portion of the tendon begin to break down causing tiny tears, swelling and thickening. Younger, active people are more often affected by this problem.
  • Insertional Achilles tendonitis — This type of tendonitis involves the lower portion of the heel where the tendon attaches (inserts) to the heel bone.
  • Additional complications of both types include painful bone spurs (extra bone growth) and the calcification or hardening of the damaged tendon fibers.

Achilles Tendonitis Symptoms
Symptoms of Achilles tendonitis can come on gradually or suddenly. According to the American Orthopaedic Foot and Ankle Society, you may feel one or more of these common symptoms:

  • Mild pain after exercise or running that gradually worsens
  • A sense of sluggishness in your leg
  • Episodes of diffuse or localized pain that can sometimes be severe along your tendon while you're running or a few hours after you've run     
  • Tenderness along your Achilles tendon in the morning
  • Stiffness that generally diminishes as your tendon warms up with use
  • Some swelling or pain in the back of your heel where the tendon attaches to the heel bone
  • Pain along the tendon or back of the heel that worsens with activity
  • Severe pain the day after exercising
  • Thickening of the tendon
  • Bone spur (extra growth of bone that can add to the pain of tendonitis)
  • Swelling that is present all the time and gets worse throughout the day with activity
  • If you have experienced a sudden "pop" in the back of your calf or heel, you may have ruptured (torn) your Achilles tendon, a more serious condition than Achilles tendonitis — see your doctor immediately.

Achilles Tendonitis Causes
Achilles tendonitis results from repetitive stress to your Achilles tendon, especially when you push your body to do too much, too soon. Other factors can enter into the picture and make it more likely for you to develop Achilles tendonitis, including:

  • Sudden increase in your exercise activity — for example, increasing the distance you run every day by a few miles without giving your body a chance to adjust to the new distance
  • Not stretching enough before exercise
  • Wearing high heels — increases the stress on the Achilles tendon
  • Flat feet — Also known as fallen arches or overpronation, flat feet and other foot problems can stretch the muscles and tendons
  • Tight calf muscles and tendons — If you suddenly start a more ambitious exercise program, it can put extra stress on the Achilles tendon, especially if you have tight calf muscles
  • Bone spur — This risk factor is the growth of extra bone where the Achilles tendon attaches to the heel bone, just enough to rub against the tendon and cause pain

Achilles Tendon Injury Treatment
Treatment options for Achilles tendon injuries range from nonsurgical approaches like rest, exercise, anti-inflammatory medications and a leg cast to Achilles repair surgery for a ruptured Achilles tendon.

Rehabilitation Services
The Rehabilitation Network of the North Shore-LIJ Health System is dedicated to providing you and your family with result-oriented, comprehensive rehabilitation services. Our goal is to help you and your loved ones find relief from pain and get moving again after an accident, illness, injury or surgery. We’re your partner in a safe, healthy, more rapid recovery.