The Achilles tendon – or to give it it’s proper name the calcaneus tendon – attaches your calf muscles (gastrocnemius and soleus) to the heel bon (calcaneus). It is part of the gastrocnemius/soleus muscles of your calf and is involved in actions of the foot and ankle. The Achilles is probably the one tendon that people will have heard of, getting it’s name from Greek mythology, which gives an idea where it is located. Although it is the largest and strongest tendon of the body, Achilles injuries are not uncommon. They can range from tendonitis, ruptures and bursitis and I’ll go through what the symptoms and treatment might be for each. Because all Achilles injury are tendon-related, you should expect recovery to take a long time. Expect them to be months rather than weeks.
What is a tendon?
Tendons attach muscles to the bone. They are made up of dense connective tissue of collagen fibres with a reduced level of blood supply compared to muscles. Their structure means that they have a great tensile strength but have very limited elasticity. Think of them as the shock absorbers for your muscles, enabling them to work with the bones to create movement. Tendons will have a normal range of limited movement, beyond which they will start to become at risk of injury.
Achilles Injuries
Strains (Tendonitis) and ruptures (partial or complete tears) are the most common injuries of the Achilles. Strains can be thought of as an ‘overuse’ type of injury. If the tendon is taken just past it’s normal range of movement repeatedly and it starts to struggle. Achilles Peritenonitis is where the sheath of the tendon becomes inflamed.
Ruptures can be partial or complete tears of the fibres. They can result from sudden changes in demand of the Achilles. Sudden changes from inactivity to activity, increased or excessive training, falling/tripping, sudden changes in movement (think of suddenly turning to go in a completely different direction) and high impact activities/sports. Footwear and the support they give to the ankle can be important. Age can play a part in the risk of ruptures. This is because tendons start to degenerate at about 25-30 years. Age can start to weaken tendons, although conversely, regular exercise can help delay this.
Achilles Tendinosis
Symptoms include:
- Stiffness in the morning and before exercise
- Localised swelling on one side of the tendon
An MRI or ultrasound scan can be used to diagnose the degree of the injury.
Treatment includes:
- Rest to avoid pain but keep active using non-weight bearing exercise such as cycling and acqua-jogging
- Rehab exercises such as stretching and eccentric strength resistance training
- The average time for recovery is 3-6 months, although it can vary.
Partial Tears of the Achilles
Symptoms for partial rupture include:
- Onset of shooting or stabbing pain sometimes at the time of injury but more commonly afterwards. The pain will recur whenever activity is resumed.
- Stiffness in the morning as well as before and after exercise
- Swelling and tenderness at the site of the rupture (you may be able to feel where the contour of the Achilles has changed)
An X-ray will show the swelling of the soft tissue, whilst an MRI can provide a more detailed assessment of the tear.
Treatment for Partial Tears:
- Rest in the acute stages of the injury
- Use crutches if the pain is severe
- Wear shoes with a 1cm heel wedge. A doctor may prescribe a walking boot for 4-6 weeks
- Follow a rehab exercise plan (promotes healing but don’t start it too soon)
The average time to a partial tear to heal can be 6-8 months. There are no short-cuts in the healing process, so don’t rush it.
Complete Tears of the Achilles
Symptoms for a complete rupture include:
- Intense pain at the site of the rupture. It can sometime feel as though you have been hit by something from behind.
- Walking normally can feel difficult. Pushing off from the foot is a challenge
- Local tenderness above the heel bone (Calcaneus) and a ‘gap’ in the tendon can be seen or felt
- The ability to point the toe downwards (plantar flexion) is impaired
An MRI or ultrasound scan can be used to diagnose a tear to the Achilles.
Treatment for complete tears:
- A specialised boot that is worn at all times. You may be given blood thinners to prevent a blood clot forming
- Surgery (not always required but an option)
Achilles Peritenonitis
Symptoms include:
- Pain in the tendon
- General (diffuse) swelling
- Intense but generalised tenderness with impaired function
- Skin redness with a creaking sensation on touch
Treatment includes:
- Rest in the acute stage
- Ice the area to reduce pain and swelling. Heat can be used after the acute stage
- A doctor may prescribe anti-inflammatories
The recovery is around 1-2 weeks
Achilles Bursitis
Bursa sacs are located throughout the body. They are sacs filled with fluid that are designed to reduce friction and cushion the spaces between muscles, tendons, ligaments and bones. They are commonly located around the joints of the body. The Achilles has 2 bursa, a superficial one and the deeper bursa in the ankle joint – the retrocalcaneal bursa, which lies between the heel bone (calcaneus) and the Achilles tendon. It can become inflamed or irritated from pressure against the tendon attachment at the calcaneus, eg from repeated dorsiflexion (pointing your foot upwards)
Symptoms include:
- Redness and thickening of the skin at the calcaneus or the outside of the ankle
- Pain, especially when going uphill or over soft ground
- Tenderness and swelling, which might make it uncomfortable to wear shoes
Treatment includes:
- Switch to shoes that do not have a back on them to relieve pressure at the back of the heel.
- A low heel on a shoe may help to counter the pressure on the bursa.
- A support ring around the bony aspect of the heel may also relieve pressure
- Apply localised heat
Recovery is usually 3-6 months.
If you are struggling with any type of Achilles injury, why not book in your next massage appointment as part of your rehab plan.
Updated October 2024