The Achilles tendon, one of the largest tendons in the body, is located in the back of the lower leg, connecting the calf muscle group to the heel (calcaneus). The calf muscles work in concert with the Achilles tendon to flex the foot downward, an action known as plantar flexion (plantar refers to the bottom surface of the foot – plantar flexion is the action of pointing the toe, or standing on the toes). Given the vital function of this structure, injuries to the achilles tendon can range from mildly irritating to completely debilitating. The most common injuries of the Achilles tendon are tendonitis and tendon rupture.
Achilles Tendon Tear
The most severe form of injury of the Achilles tendon is complete tear. Risk factors for Achilles tendon tear include:
- Age – Achilles tendon tears are more common in athletes over age 30.
- Poor conditioning – Individuals who are in poor physical condition are vulnerable to tears during sudden exertion.
- Medications – Patients using long term corticosteroids or on fluoroquinone antibiotics are vulnerable to tears of the Achilles tendon.
The mechanism of injury for Achilles tendon tear include sudden forced plantar flexion of the foot, unexpected dorsiflexion of the foot, and violent dorsiflexion of a plantar flexed foot. Another, less common cause is direct trauma to the heel.
Achilles Tendonitis
Achilles tendonitis is a common cause of heel pain. The tendon undergoes degeneration over time, resulting in impaired tendon function and pain. Studies have shown that the cause of pain is degeneration and inflammation. Risk factors for Achilles tendonitis include:
- Overuse – athletes coming back from a period of inactivity, or rapidly increasing the level or intensity of training in a short period of time are vulnerable.
- Inappropriate footwear – athletes wearing high heeled shoes consistently may aggravate the tendon when training in standard running shoes.
- Excessive hill training – running up hills slightly overstretches the Achilles tendon with each stride, which can lead to inflammation.
Treatment of Achilles Tendon Tears
Most Achilles tendon tears are sudden, devastating injuries. Acute tears are immobilized for several weeks, to allow the initial swelling to subside. After a tear, the portion of the tendon separated from the heel moves upward, or retracts, toward the upper calf region. This results in a wide gap between the margins of the torn tendon. The tear will usually not heal spontaneously, and surgery is required. Some tears will be treated conservatively, and allowed to heal naturally. This is not the preferred method of treatment for most tears, and is usually reserved for older, inactive individuals who may not tolerate surgery well.
Treatment of Achilles Tendonitis
Achilles tendinitis is treated with rest, stretching, and anti-inflammatory medication. After diagnosis, the affected tendon is placed at rest. All strenuous athletic activities are stopped, and a heel pad may be used in all footwear. This provides cushioning for the heel, and slightly elevates the heel, which relieves pressure. Anti-inflammatory medication, such as ibuprofen, are used to relieve pain and stop the inflammatory process. Finally, sports massage and ultrasound treatments may be utilized to speed recovery.
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