The two main types of Achilles tendon injuries are:
Rupture: Completely torn tendon
Tendinitis: Inflammation in the tendon
- Mid-substance tendinitis occurs in the middle of the tendon and often results from overuse.
- Insertional tendinitis develops at the end of the tendon where it connects to the heel bone and usually occurs in people who are less active.
A common factor in both types of tendinitis is tightness in the calf muscle. That’s why Patrick Maloney, MD, an orthopedic surgeon and foot and ankle specialist with Orthopaedic Associates of Central Maryland, recommends that patients stretch their calves several times each day, and especially before strenuous activity or sports.
Conservative Treatment for Achilles Tendon Injuries
For tendinitis, Dr. Maloney begins treatment with non-steroidal anti-inflammatory medication (NSAIDs) such as ibuprofen or naproxen, along with rest and stretches for the calf and Achilles tendon.
If these options don’t work, the next step is a fracture boot to immobilize the foot and ankle. “You may need the boot from one to six weeks, depending on how long it takes for you to feel better,” says Dr. Maloney.
Traditionally, doctors have treated Achilles ruptures with surgery to repair the tendon. However, orthopedic surgeons now consider nonsurgical care almost as effective as surgery without its risks, such as infection and wound healing problems.
Surgery for Achilles Tendon Ruptures and Tendinitis
If tendinitis or rupture does not improve with conservative treatments, surgery may be indicated. For tendinitis, the surgeon makes an incision, removes any scar or dead tissue and reattaches the tendon. For ruptures, the surgeon either stitches the tendon back together where it tore, or reattaches the tendon to the heel bone.
Recovering from Achilles Tendon Injuries
People usually recover from tendinitis within about six to eight weeks, if they haven’t had surgery.
For Achilles ruptures, the recovery is a longer process and is about the same for conservative care or surgery. “I tell my patients that a rupture is a year-long process for recovery, until they can get back to their pre-injury level of activity,” says Dr. Maloney.
For patients who have had surgery to repair the tendon, the foot and ankle is immobilized for four to six weeks with minimal weight bearing. About two weeks after surgery or injury, a rehabilitation program begins. “You should continue physical therapy for at least six and up to 18 months,” says Dr. Maloney.
It’s critical for patients to stick with their rehab program for the long haul. Dr. Maloney explains, “It takes three to four months for the tendon to fully heal. Then it’s another six to 12 months to get your strength and flexibility back to pre-injury level.”
Benefits of Seeing a Foot and Ankle Specialist
Foot and ankle specialists like Dr. Maloney have the latest training and more experience with the newer, more advanced surgical techniques for Achilles tendon injuries. And physical therapy, with or without surgery, is key for the best possible outcomes over the long term. “If you follow the protocols, you can get back to your pre-injury level of activity or sport,” says Dr. Maloney.
Preventing Achilles Tendon Injuries
“Flexibility in your calf muscles and Achilles tendon is key to preventing injuries,” notes Dr. Maloney, “which means regular stretching.” He also advises people who want to start or increase their level of exercise to do so gradually. “That way, your body can adjust to the increased activity.”