Achilles tendinitis and tendon rupture

Achilles tendon is the tissue which connects the calf muscles to your heel bone. Overuse and degeneration of this tissue lead to a condition called Achilles tendinitis.

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Symptoms

Initially, a mild pain is presented in the back of the leg immediately after activities like running or jumping. The pain becomes more severe with prolonged running or climbing stairs.

Tenderness or stiffness may be present in the early hours of the day which may improve with mild activity.

If you have heard a sudden pop sound in the back of your calf, then it might be due to the rupture of your Achilles tendon. This requires immediate medical attention.

Achilles tendon rupture requires immediate surgical treatment. It is characterized by a sharp pain as if someone is hitting on the back of your heel with a stick.

Causes

Achilles tendonitis is caused by straining the calf muscles by repeated physical activity or a sudden increase in the speed or amount of any activities such as running or jumping. This can cause inflammation of the tendons and is termed as Achilles tendinosis.

In middle-aged people, Achilles tendonitis due to tendon injury can occur if they play games such as tennis or basketball rarely and not every day in the week. This is due to abrupt increase in the intensity of their leg movement.

In some instances, rheumatoid arthritis is also associated with this condition.

Risk factors

The risk of developing Achilles tendinitis is high in elderly males; people with a family history; and in patients, who are obese, have psoriasis or high blood pressure, tight calf muscles. The risk also increases with certain antibiotics (e.g. fluoroquinolones) and is high during cold weather. Running in hilly terrains can also increase the risk of getting Achilles tendon.

When to seek medical advice?

You need medical attention when the pain is severe or mild but persistent, as it can lead to tendon rupture or tendon tear.

Before consulting a doctor get prepared with questions such as:

  • How is the progress of pain?

  • What is the quality of your footwear?

  • Is the severity of the symptoms associated with time or activities you perform?

  • Are you taking any medications or supplements?

  • Did you switch to a different exercise schedule?

  • Are you following any pain relief strategies?

As a part of the physical examination, your physician will gently press the affected area to locate the pain, tenderness, and swelling. Additionally, the flexibility, range of motion, alignment and the reflexes of the affected area are observed. For further evaluation, any one of the below tests may be ordered:

Test type Purpose of the test
X-rays To exclude other conditions with similar symptoms
MRI To get a more detailed picture of the Achilles tendon
Ultrasound To observe the tendon during movement and to evaluate circulation to the tendon

By taking certain measures at home, most of the people with tendinitis improve. However, patients with severe symptoms need other treatment options which may include:

Medications:You may be given strong pain relievers and anti-inflammatory agents to relieve the associated pain and inflammation.

Physical therapy:You may be suggested to perform certain exercises and stretches to strengthen the Achilles tendon, or to use orthotic devices to reduce the pressure on the Achilles tendon.

Surgery:If you do not improve with the above treatments then you may have to undergo surgery to repair the Achilles tendon.

You can take certain measures to overcome the Achilles tendinitis problem. They include:

Rest:The first step is to rest the damaged foot. Do not perform activities which put pressure on Achilles tendon. Instead, you can go for activities such as swimming, biking, etc. If your condition is more severe, then you may have to use crutches or wear boots.

Ice:Placing ice on the painful area for about 15-20 minutes can reduce the pain as well as swelling. You may do this all through the day as needed.

Compression:Compressive elastic bandages can be wrapped around the affected tendon to reduce swelling and prevent excessive movement of the tendon.

Elevation:Raise your foot above the level of your heart to reduce circulation, thereby reducing swelling. While sleeping at night, keep the foot elevated.

Overtime, Achilles tendinitis can make the weakened tendon to rupture which can be repaired only with surgery.

Excessive immobility can lead to tendon stiffness and DVT (deep vein thrombosis, i.e. blood clots in the legs).


Prevention

By taking some proactive measures, you can reduce your risk of developing Achilles tendinitis. They include:

Be slow and steady:Do not suddenly increase the intensity of your exercises, instead adopt a gradual progress.

Switch between high and low:Perform high-impact activities followed by low-impact activities alternatively.

Be cautious:Do not perform vigorous exercises which cause strain on the tendon. If you have to, then initially do warm ups followed by the strenuous exercises. If you have pain with any exercise, stop doing it and rest your leg.

Choose cushioning shoes:Pick the shoes which support your Achilles tendon while exercising and provide the cushioning effect to prevent strain on the tendon.

Stretch every day:Before and after performing exercises, stretching your calf muscles is important. This strengthens your calf muscles to handle the stress during exercises.