Achilles Tendon Injury

What is an Achilles tendon injury?

The Achilles tendon is a band of tissue that connects the heel bone to the calf muscle of the leg. Injury to the tendon may cause it to become inflamed or torn.

Achilles tendonitis is the term used when the tendon is inflamed. The inflammation causes pain at the back of your leg near the heel. A tear of the tendon is called a rupture. It also causes pain near your heel.

How does it occur?

• Achilles tendonitis can be caused by:
• overuse of the Achilles tendon
• tight calf muscles
• tight Achilles tendons
• lots of uphill running
• increasing the amount or intensity of sports training, sometimes along with switching to racing flats, which are racing shoes with less heel lift
• overpronation, a problem where your feet roll inward and flatten out more than normal when you walk or run
• wearing high heels at work and then switching to lower-heeled shoes for exercise.

An Achilles tendon may tear during sudden activity. For example, the tendon might tear when you jump or start sprinting.

Symptoms

Achilles tendonitis causes pain and may cause swelling over the Achilles tendon. The tendon is tender and may be swollen. You will have pain when you rise up on your toes and pain when you stretch the tendon. The range of motion of your ankle may be limited. When the tendon tears or ruptures, you may feel a pop. If there is a complete tear, you will be unable to lift your heel off the ground or point your toes.

Diagnosis

Your health care provider will examine your leg, looking for tenderness and swelling. Your provider will watch your feet when you walk or run to see if you overpronate.

Treatment

Treatment for Achilles tendonitis and strain are very similar:

Stretching

Towel Stretch
Sit on a firm surface with your injured leg stretched out in front of you. Loop a towel around the ball of your foot and gently pull the towel toward your body while keeping your knee straight. Hold for 30 seconds and repeat 3 times.
As soon as you can tolerate pressure on the ball of your foot, begin stretching your ankle using the towel stretch. When this becomes easy, progress to the standing calf stretch and the soleus stretch.

Standing Calf Stretch
Stand facing a wall with your hands at about eye level. Place your uninjured leg forward and your injured leg back about 12–18 inches. Keep your injured leg straight, heel on the floor, and toes pointed toward the wall. Bend the front knee slightly and lean toward the wall until you feel a stretch in your calf. Hold for 30–60 seconds and repeat 3 times.

Half-Kneeling Ankle Mobility
Start in a lunge position with your uninvolved knee on the floor and your involved leg in front at a 90-degree angle. Keep your foot flat and knee stacked over your ankle. Slowly shift your hips forward so your knee moves over your toes. Hold for 5–10 seconds, then return to the starting position. Perform 3 sets of 10 repetitions.

Ankle Alphabets
Sit or lie down and pretend you are writing the alphabet in the air with your foot. The movement should come from your ankle, not your hip or knee. Complete the alphabet twice.

Strengthening

Heel Raises
Stand on the floor or a small step and hold a wall or railing for support. Rise up onto your toes, hold for 5 seconds, then slowly lower back down. Do 3 sets of 10 repetitions. When comfortable, progress to doing them on one leg.

Resisted Dorsiflexion
Sit with your leg straight and loop a resistance band around the ball of your foot, anchoring the other end to a door or having someone hold it. Pull your toes toward your face, then slowly return to the starting position. Do 3 sets of 10 repetitions.

Resisted Plantar Flexion
Sit with your leg outstretched and loop a resistance band around the ball of your foot, holding both ends in your hands. Gently press the ball of your foot downward and point your toes, then slowly return to start. Do 3 sets of 10 repetitions.

Resisted Inversion
Sit with your legs straight and cross your uninjured leg over your injured ankle. Wrap a resistance band around the ball of your injured foot and anchor the other end around your opposite foot or hold it in your hand. Turn your injured foot inward and upward, then slowly return to start. Do 3 sets of 10 repetitions.

Lunges
Stand in a split stance with your hands on your hips. Slowly bend both knees toward a 90-degree angle, lowering your hips while keeping your chest upright. Your back knee should hover just above the floor and your front knee should stay stacked over your ankle. Do 3 sets of 10 repetitions on each leg.

When can I return to my activity?

The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon, you may worsen your injury, which could lead to permanent damage. Everyone recovers at a different rate. Returning to your sport or activity will be determined by how soon your ankle recovers, not by how many days or weeks it has been since your injury has occurred. In general, the longer you have symptoms before you start treatment, the longer it will take to get better. You may safely return to your sport or activity when, starting from the top of the list and progressing to the end, each of the following is true: – You have full range of motion in the injured ankle, compared to the uninjured ankle – You have full strength of the injured ankle and hip compared to the uninjured ankle and are able to complete the above exercises without pain – You can jog straight ahead without pain or limping – You can sprint straight ahead without pain or limping – You can jump on both legs without pain, and you can jump on the injured leg without pain Return to your sport at about 50% effort, and increase by about 10% each week. If you begin with pain, you may need to rest for a few days before returning to activities.

Prevention

The best way to prevent Achilles tendon injury is to stretch your calf muscles and Achilles tendons before exercise. If you have tight Achilles tendons or calf muscles, stretch them twice a day whether or not you are doing any sports activities that day.

If you have a tendency to get Achilles tendonitis, avoid running uphill a lot.