What is the Achilles tendon?

The Achilles tendon is a tough band of fibrous tissue that connects the calf muscles to the heel bone. The Achilles tendon is also called the calcaneal tendon. Achilles tendon disorders are common in middle-aged active people, and tith increasing sports participation in the general population, the number of overuse injuries has increased. The Achilles tendon helps you point your foot downward, rise on your toes and push off your foot as you walk. You rely on it virtually every time you walk and move your foot.

What are the signs and symptoms?

A ruptured Achilles tendon is characterised by:

  • The feeling of having been kicked in the calf
  • Pain, possibly severe, and swelling near the heel
  • An inability to bend the foot downward or "push off" the injured leg when walking
  • An inability to stand on the toes on the injured leg
  • A popping or snapping sound when the injury occurs

What are the causes?

Rupture usually occurs in the section of the tendon situated within 2 1/2 inches (about 6 centimetres) of the point where it attaches to the heel bone. This section might be prone to rupture because blood flow is poor, which also can impair its ability to heal. Ruptures often are caused by a sudden increase in the stress on your Achilles tendon, for example:

  • Increasing the intensity of sports participation, especially in sports that involve jumping
  • Falling from a height
  • Stepping into a hole

How is it diagnosed?

Achilles tendon pain is usually localised to the tendon itself, and a thorough examination will find that swelling in the tendon midportion may be obvious. An additional ultrasound or MRI may be useful for verifying the diagnosis and planning the surgical procedure.

How is it treated?

Treatments typically include rest, avoiding activities that cause pain, ice, and anti-inflammatories. If the pain persists or comes back with resumption of activities, physical therapy will be recommended. This will include improving the flexibility of the hamstring and calf musculature, stretching the tendon, and starting a specialised strengthening program. If pain persists, the doctor may consider a patch that increases blood flow to the tendon. In rare cases, the doctor may recommend a needle procedure that stimulates healing of the tendon. Surgery is not generally recommended unless there is a large tear of the tendon.

How can it be prevented?

Ways to reduce the chance of developing Achilles tendon problems include stretching and strengthening the calf muscles, varying exercises between high and low impact, avoid running on uneven or slippery surfaces, and increase training intensity slowly no abruptly.