Topics discussed on this web page:
diagnosis and treatment of:
Achilles Tendon Ruptures
is the Achilles Tendon?
Achilles Tendon is the large tendon running from the calf muscles (the
gastrocnemius and soleus muscles) located in the back of the
leg to the back of the heel. This
muscle and tendon combination is responsible for allowing your foot
to push off the ground when you're walking, running, and jumping.
is Achilles Tendinitis?
it's used so much in gait, the tendon is susceptible to injury.
In the earliest stages, the tendon becomes inflamed. At
this point we would name the problem "Achilles Tendinitis",
because adding the suffix -itis to the end of a word means
that tissue is inflamed.
is Achilles Tendinosis?
Tendinosis" is a term used when the inflammatory condition of the
tendon progresses and actual
degeneration of the tendon develops from small tears within the
tendon. These tears have a difficult time healing because of the
limited circulation and the chronic irritation to the tendon.
is an Achilles Tendon rupture?
the small tears in the tendon worsen, the entire tendon tends to weaken.
Eventually it may simply "give way" and tear in half. This is
a tendon rupture.
are these problems seen?
most common location for the problem to develop is approximately 2/3
of the way down the tendon, about 2.5 inches, or about 5 cm from where
it attaches to the heel bone. This location is predisposed
because this area has less blood flow than other portions of the
do you develop these conditions?
Sometimes Achilles Tendinitis is a result of sudden trauma,
as you might encounter from playing sports, but you can also have Achilles
tendon pain as a result of small, unnoticed, day-to-day
irritations that inflame the tendon over time by a cumulative effect. In
those with no history of trauma, Achilles Tendonitis is sometimes
associated simply with long periods of standing.
are several factors that can cause the gradual development of Achilles
Tendinitis. Improper shoe selection,
particularly using high heels over many years, increases your odds of
developing the condition. This is because high-heeled shoes cause your
calf muscles to contract, leaving the tendon with a lot less slack in it.
stretching before engaging in athletic or other physically-demanding
activities also predisposes you to develop the problem. This is
especially true in "weekend athletes", individuals who tend to
partake in excessive physical activities on an intermittent
abnormalities like excessive
much flattening of the arch) also tends to cause this condition.
And it is much more common individuals with
It is more common in
the middle-aged, the out-of-shape, smokers, and in those who use steroids.
Men get the condition more frequently than women.
Those involved in
jumping and high-impact sports are particularly vulnerable.
does Achilles Tendinitis feel like?
vary because you can injure various areas of the muscle-tendon complex. The
pain may be an acute or chronic sharp, stabbing, piercing, shooting, burning or aching.
is often most noticeable immediately after getting out of bed in the morning,
or after periods of inactivity, like sitting down for lunch. After a
couple minutes of walking around, it will often then settle down
somewhat, before becoming symptomatic again after excessive time standing
regardless of how the pain is perceived, Achilles tendon pain should not
be left untreated due to the danger that the tendon can become weak, frayed,
thickened, and eventually it may rupture.
does Achilles Tendinosis feel like?
are similar to Achilles Tendinitis, though discomfort associated with Achilles
Tendinosis tends to stay rather constant because the tendon is
do Achilles Tendon ruptures feel like?
may hurt a great deal, but they are frequently characterized by a surprisingly
non-painful dull whack, like someone hitting the back of the tendon with a
tennis racket. There is often an inability to continue walking, though
some are able to continue walking by the body's ability to recruit other muscles
in the calf to take
over the Achilles Tendon's job.
How can you diagnose
A podiatrist can usually
make the diagnosis by clinical history and physical examination alone. Pain
with touching or stretching the tendon is typical. There may also be a
visible swelling to the tendon. The patient frequently has difficulty
plantarflexing (pushing down the ball of the foot and toes, like one would
press on a gas pedal), particularly against resistance.
In most cases X-rays don't
show much, as they tend to show bone more than soft tissues. But X-rays
associated degeneration of the heel bone that is common with Achilles Tendon
problems. For example, heel spurs, calcification within the tendon,
avulsion fractures, periostitis (a bruising of the outer covering of the bone)
may all be seen on X-ray.
In cases where
we are uncertain as to the extent of the damage to the tendon, though, an MRI
scan may be necessary, which images the soft tissues better than X-rays. When
the tendon is simply inflamed and not severely damaged, the problem may or may
not be visible on MRI. It depends upon the severity of the condition.
How do you
diagnose Achilles Tendinosis?
are usually not of great help because they image bone.
Calcifications of the tendon, however, may be visible with
X-ray. Better imaging of soft tissues may be performed with MRI,
and tendinosis is often visible with MRI.
To the right
is an example of an MRI that demonstrates degeneration of the Achilles
How do you diagnose Achilles
Clinically, a history
and physical examination is usually enough to diagnose an Achilles Tendon
A visible gap or
depression in the affected area is unique to ruptures, however, and there is a
greater loss of function and ability to plantarflex, or push down, the foot
"Thompson Test" may be helpful, too. This is where the calf
muscle is squeezed by the doctor and the foot should
But while Achilles
Tendon ruptures can usually be diagnosed with a clinical examination alone,
MRI is probably the easiest way to identify beyond doubt the presence of a
MRI the right demonstrates an obvious rupture.
How can you treat
Complete rest is vital, and ice is of great help the first 2 days of the
injury. (Apply ice 15 minutes every hour). Taping, padding,
heel lifts, anti-inflammatory medications, immobilization, physiotherapy, massage,
shoe modifications are all helpful in the acute stage.
injections weaken tendon and should not be used in most cases.
shockwave therapy (or ESWT) can also be used to promote healing of Achilles
Tendinitis, as well, particularly where it attaches to your heel bone.
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chronic, difficult-to-treat cases,
custom-made appliances for the shoes, may be necessary to address
any biomechanical abnormality. Good shoes and, in athletes, a
strict pre-activity stretching regimen are also helpful in the long term.
you treat an Achilles Tendinosis?
stages may be responsive to conservative care as described in the Achilles
Tendinitis section above. As degeneration progresses, though,
reconstructive surgery of the tendon may be required.
you treat Achilles Tendon Rupture?
We would most likely suggest
surgical repair of the tendon, particularly of fresh injuries.
injuries are also usually treated surgically, though some patients will improve by
simply casting the leg and allowing the tendon to scar together.
and function, is more frequently
seen in patients who are casted without surgery, and the tendon is more likely
to re-rupture, so the inclination is to
surgically repair ruptures in most cases involving younger, healthier
surgical repair of Achilles Tendon injuries, the patient is usually casted, then
when the cast is removed, the patient is followed up with stretching,
strengthening exercises, and physiotherapy.
morbidity (chronic abnormal function) following ruptures is common,
particularly if the tendon injury isn't treated promptly, in the elderly and
obese, in individuals who have used steroids, in individuals with
rheumatological (arthritic) conditions, and in those who haven't
followed sound post-surgical physical therapy guidelines.