Achilles Tendon Injury
The Achilles tendon is the largest tendon in the body, connecting the calf muscles to the heel bone. Common injuries to the Achilles tendon in kids are overuse injuries, such as tendonitis. In rare cases, injuries may include tears (partial or full).
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Causes
There are a number of reasons why an Achilles tendon injury may occur. Some common ones include:
Lack of stretching and proper warm up or cool down
Overexercising or training
Training on uneven surfaces
Having flat feet
Wearing improper footwear
Symptoms
Common symptoms related to an Achilles tendon injury are:
Achy pain
Stiffness
Swelling
Difficulty walking
Popping or snapping sound at time of injury
Diagnoses
To determine if your child has an Achilles tendon injury, our specialists will perform a physical exam that includes flexibility tests, stress tests, muscle tests and gait analysis. These tests will help our specialized team better understand your child’s condition, assess range of motion and identify abnormalities that might occur in bone alignment or muscle function.
After a physical exam, our specialists may also order imaging tests such as X-ray, MRI, or ultrasound.
Treatments
Possible non-surgical treatments your doctor may offer or recommend to treat your child’s Achilles tendon injury include:
Activity modification
Physical therapy
Steroid injections
Prescription medications
At-Home Care
Common at-home treatment options for Achilles tendon injuries include:
Resting:
the area and/or taking time off from active sports and hobbies.
Icing the Area:
Put ice packs wrapped in a towel or thin cloth on your child’s ankle for 20–30 minutes every 3-4 hours for the first 2-3 days. If pain does not go away, contact your healthcare provider.
Elevating the Injured Limb:
Elevate your child’s lower leg by placing it on a pillow when your child is lying down. Elevating it above the heart level can help reduce swelling and pain.
Taking Non-Prescription Medication:
Take a non-steroidal, anti-inflammatory drug (NSAID), such as ibuprofen as recommended by your healthcare provider.
Exercising:
Your doctor may recommend doing exercises at home. These are designed to stretch the affected ankle, maintain range of motion in the joint and strengthen your child’s ankle.
Modify activity level:
Participate in lower impact activities like walking, swimming or bike riding and avoid painful activities such as running and jumping.
Also Note:
While you are recovering from your injury, change your child’s sport or activity to one that does not make the condition worse—for example, your child may need to swim instead of run.
Do all rehabilitation exercises recommended by your child’s doctor to stretch and strengthen the Achilles tendon once your child can walk without a limp.
If you overpronate (foot rolls inward), your healthcare provider may prescribe a made shoe insert (orthotic) to help keep your foot stable.
In severe cases of Achilles tendonitis, your child might have to use an ankle brace or removable cast for several weeks.
If the Achilles tendon is completely torn, your child might need surgery. Recovery generally includes being in a cast for 6-10 weeks along with physical therapy and exercise.
Rehabilitation Exercises
Below are common exercises a doctor may recommend to help your child recover after an Achilles tendon injury. Always check with your doctor to find out which exercises are right for your child.
Stretching
As soon as your child can tolerate pressure on the ball of their foot, they can begin stretching the ankle using the towel stretch by following the directions shown below. When this stretch has become manageable, progress to the standing calf stretch and the standing soleus stretch.
Towel Stretch
Sit on a hard surface with injured leg stretched out in front.
Loop a towel around the ball of the foot.
Pull the towel toward the body keeping knee straight.
Hold for 30 seconds. Repeat 3 times.
Standing Calf Stretch
Facing a wall, put hands against the wall at about eye level.
Keep the uninjured leg forward and the injured leg back about 12-18 inches.
Keep the injured leg straight and the heel on the floor.
Keep toes pointed towards the wall.
Next, do a slight lunge by bending the knee of the forward leg. Tell your child to lean into the wall until they feel a stretch in the calf muscle.
Hold for 30-60 seconds. Repeat 3 times.
Standing Soleus Stretch
Facing a wall, put hands against the wall at about eye level.
Keep the uninjured leg forward and the injured leg back about 4-6 inches behind the uninjured leg.
Tell your child to keep both heels on the ground and gently bend their knees until they feel a stretch in the calf muscle.
Hold for 30-60 seconds. Repeat 3 times.
Range of Motion
When the ankle swelling has stopped, try the ankle range of motion exercise described below. Your child may move on to the strengthening exercises when they can bear weight on their injured ankle without pain.
Ankle Range of Motion
Tell your child to pretend they are writing each of the letters of the alphabet with their foot.
Move ankle in all directions.
Do this exercise sitting or lying down.
Ask child to draw pictures of animals, like a cat or a giraffe, if they don’t yet know the alphabet.
Do twice.
Strengthening
Double Heel Raises
While standing, balance on both feet behind a chair.
Rise up on toes, hold for 5 seconds, then lower back down.
Repeat 10 times. Do 3 sets of 10.
Single Heel Raises
Hold onto a table and balance on injured side.
Lift heel off the ground.
Repeat 10 times, twice a day.
Perform without holding onto anything for a greater challenge.
When Will My Child Return to Play?
After your child has had a musculoskeletal injury like an Achilles tendon injury, it’s normal to want to know how long the injury will take to heal and what you can expect.
Every child is unique, every injury is different and your doctor will be able to give you general guidelines as to when your child may be able to return to play. In other words, there is no way to speed up the process and trying to do so may make matters worse, and could make your child’s recovery take even longer.
The best thing you can do for your child is to make sure you consistently follow your doctor’s instructions, including doing at-home exercises regularly. When it is okay to do so, our doctors and staff will let you know when your child can return to play at a controlled level.
How to Prevent Achilles Tendon Injuries
Take time to engage in a proper warmup and cool down with stretching and strengthening
Don’t over exercise
Don’t train on concrete or uneven surfaces
Wear proper footwear