Achilles Tendon Injuries

What is the Achilles Tendon?

The Achilles tendon is the largest and strongest tendon in your body, connecting your calf muscles (gastrocnemius and soleus) to your heel bone (calcaneus). This powerful fibrous cord is essential for walking, running, jumping, and pushing off on your toes. Its strength and flexibility allow you to point your foot downward and rise on your tiptoes, making it fundamental to everyday movement.

Types of Achilles Tendon Injuries

Achilles tendon injuries generally fall into two categories:

• Tendonitis, which is inflammation from overuse
• Tears or ruptures, which result in partial or complete splitting of the tendon fibers.

The severity of an injury can range from microscopic tears in the tissue to a complete break of the tendon. Understanding the type of injury is the first step toward effective treatment.

Partial Tear

A partial tear involves the tearing of some, but not all, of the tendon fibers. This type of injury can result from a sudden force or develop over time due to repetitive stress. The symptoms may be less dramatic than a full rupture, often presenting as pain, swelling, and weakness in the lower leg.

Complete Rupture

A complete rupture is a full tear of the Achilles tendon, resulting in a complete separation of the tendon fibers. This injury often happens with a sudden, forceful push-off motion and is frequently accompanied by a popping sound or sensation in the back of the ankle. A complete rupture causes significant pain, swelling, and an inability to push off the injured foot.

Common Causes & Risk Factors

Achilles tendon injuries are often caused by a sudden increase in the amount or intensity of physical activity. They can also result from direct trauma or underlying conditions that weaken the tendon. Certain factors can increase your risk of sustaining this type of injury.

Common risk factors include:

• Age: The Achilles tendon weakens with age, making it more susceptible to injury in people over 30.
• Physical Activities: Sports that involve quick stops, starts, and jumping, such as basketball, tennis, and soccer, place high stress on the tendon.
• Weekend Warriors: Individuals who participate in intense sports only on weekends are at a higher risk.
• Foot Mechanics: Having flat feet can put more strain on the Achilles tendon.
• Medications: Certain antibiotics and steroid injections can weaken the tendon and increase the risk of rupture.

Symptoms of Achilles Tendon Injuries

The symptoms of an Achilles tendon injury can vary depending on the severity of the damage. It is important to recognize these signs early to seek appropriate medical care.

Key symptoms to watch for are:

• A "pop" or snapping sensation in the back of the heel at the time of injury.
• Severe pain and swelling near your heel.
• An inability to bend your foot downward or "push off" when walking.
• Difficulty standing on your toes on the injured leg.
• A visible gap or depression in the tendon, about two inches above the heel bone.

Diagnosing an Achilles Tendon Injury

An accurate diagnosis is crucial for creating an effective treatment plan. At The Centers for Advanced Orthopaedics Orthopaedic Associates of Central Maryland Division, our specialists will perform a comprehensive physical exam to assess your injury. We will discuss your symptoms and how the injury occurred to understand its nature fully.

During the examination, your doctor will feel for a gap in the tendon and may perform the Thompson test, which involves squeezing the calf muscle to see if the foot flexes. While a diagnosis can often be made clinically, imaging tests like an ultrasound or MRI may be used to confirm the extent of the tear and rule out other conditions.

Achilles Tendon Rupture Treatment Options

Our primary goal is to restore function and relieve pain through a treatment plan tailored to your specific injury, age, and activity level. We prioritize a patient-centered approach, exploring all appropriate options with you. Treatment can range from conservative care to advanced surgical procedures.

Nonsurgical Treatment

For less severe injuries, such as partial tears or in cases where surgery is not advisable, nonsurgical treatment can be effective. This approach focuses on allowing the tendon to heal naturally while managing symptoms.

Nonsurgical methods include:

• I.C.E. Protocol: Rest, ice, compression, and elevation to reduce pain and swelling.
• Immobilization: Using a cast or walking boot to keep the foot in a flexed position, allowing the tendon ends to heal.
• Physical Therapy: Gentle exercises to strengthen the calf muscles and improve flexibility once healing has begun.

Advanced/Minimally Invasive Treatment

For certain patients, advanced and minimally invasive options can bridge the gap between conservative care and traditional surgery. These techniques aim to promote healing and restore function with smaller incisions and potentially faster recovery times. Your specialist will determine if you are a candidate for these procedures.

Surgical Treatment

Surgery is often recommended for complete ruptures, especially for active individuals who wish to return to high-impact sports. The procedure involves stitching the torn ends of the tendon back together. The surgeons at The Centers for Advanced Orthopaedics Orthopaedic Associates of Central Maryland Division are highly skilled in performing these delicate repairs.

The decision to pursue surgery is made collaboratively by both the patient and their physicians, weighing the benefits of a stronger repair and lower re-rupture rate against the risks associated with any surgical procedure. Our team will provide you with all the information you need to make a confident choice about your care.

Rehabilitation & Recovery

The recovery timeline for an Achilles tendon injury varies, but it often involves several months of progressive therapy, starting with gentle range-of-motion exercises and advancing to strengthening activities. Our team will guide you every step of the way, ensuring you are healing properly and safely.

Recovery is a gradual process that requires a dedicated rehabilitation program. Whether you undergo surgical or nonsurgical treatment, physical therapy is essential for regaining strength, flexibility, and mobility. Your commitment to the rehabilitation plan is critical for a successful return to your normal activities.

Tips for Preventing Achilles Tendon Injury

Preventing an Achilles tendon injury is always preferable to treating one. By incorporating a few simple practices into your routine, you can reduce your risk of injury.

• Stretch daily: Focus on stretching your calf muscles and Achilles tendons, especially before and after exercise.
• Increase activity level gradually: Avoid sudden, intense increases in your training regimen.
• Choose proper footwear: Wear shoes that provide adequate cushioning and support for your activities.
• Vary your exercises: Crosstrain with low-impact activities like swimming or cycling to reduce stress on your tendons.
• Listen to your body: Rest and seek advice if you feel pain or tightness in your lower leg.

When to See a Specialist

You should see a specialist immediately if you suspect you have ruptured your Achilles tendon, especially if you heard a "pop" followed by immediate pain. For ongoing pain or stiffness in the back of your heel, an evaluation can provide a diagnosis and prevent a more serious injury.

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