What are Achilles tendon injuries?

The Achilles tendon (often simply called the ‘Achilles’) is the thick cord you can feel at the back of your ankle. It attaches the calf muscle to the back of your heel.

The 2 most common injuries of the Achilles tendon are:

• Acute rupture (break): a complete or partial tear that occurs when the tendon is stretched beyond its natural range.
• Achilles tendinopathy (previously known as ‘tendinitis’ or ‘tendonitis’): a chronic (long-term) condition that causes weakness and breakdown of the Achilles tendon, due to a series of very small tears (also known as ‘tendinosis’).

What are the symptoms of Achilles tendon injuries?

The symptoms of Achilles tendinopathy include:

• mild to severe pain and tenderness in the Achilles tendon area
• weakness or stiffness at the back of your heel (the stiffness may be more noticeable in the morning and get better as the tendon warms up with use)
• swelling
• decreased strength and movement

If you partially tear your Achilles, it can feel like tendinopathy. If you completely tear or rupture your Achilles, it can feel like a kick or hit to the back of the ankle. You might have trouble walking.

If you have pain under the heel, it is usually not an Achilles tendon problem.

What causes Achilles tendon injuries?

Achilles tendinopathy is caused by excessive loading of the Achilles tendon. Causes include:

• a sudden increase in physical activity, or less recovery time between activities
• wearing unsupportive shoes
• running on hard or uneven surfaces
• tight or weak calf muscles
• not enough warm up

Achilles tendon rupture can be due to:

• forceful jumping or pivoting
• sudden bursts of running
• falling or tripping
• illness or medicines, such as steroids or certain antibiotics, that weaken the tendon (less common)

Achilles tendon ruptures are common and are most often seen in middle aged people who play high-energy sport in their spare time.

When should I see my doctor?

If you are having pain, weakness, stiffness, swelling or reduced movement at the back of your heel, you may have an Achilles tendon injury so see your doctor for a diagnosis and a treatment plan.

If you were previously diagnosed with an Achilles tendon injury, and have followed your doctor’s treatment plan but you are still in pain, go back and ask your doctor or physiotherapist for more advice.

How are Achilles tendon injuries diagnosed?

To diagnose a tendon injury, your doctor or physiotherapist will examine you and ask about your symptoms. You may need an ultrasound or other scan such as an x-ray or MRI to help diagnose the problem, but this is often not needed.

How are Achilles tendon injuries treated?

If you think you may have hurt your Achilles tendon, it is a good idea to stop any activity and carry out the RICER treatment for 2 to 3 days:

• Rest
• Ice
• Compression
• Elevation
• Referral for treatment (see your doctor)

Your doctor may prescribe anti-inflammatory medicines to help manage your pain. Most Achilles tendon injuries can be treated without surgery.

Depending on the type of injury, your doctor or physiotherapist may advise you to:

• keep your weight off your ankle (for example, by using crutches)
• do stretching and strengthening exercises
• tape your foot and heel
• use orthotics (specially designed inserts placed into a shoe)

How can Achilles tendon injuries be prevented?

You can help protect your Achilles tendons by:

• wearing supportive shoes
• warming up and stretching before and after exercise
• gradually building up your level of physical activity
• resting between workouts
• doing exercises that strengthen your calf muscles

What are the complications if I rupture (tear) my Achilles?

If your Achilles is completely torn, you should see a doctor or go to a fracture clinic as soon as possible. Treating the injury quickly will reduce your risk of long-term damage or weakness. Your doctor may recommend you wear a specially fitted boot to reduce and control how your ankle moves while your tendon heals.

In some situations, you may need surgery to repair your torn Achilles tendon, but for most people, this is not needed.

Some people need a program of rehabilitation that can last for 4 months or longer.

Resources and support

Call healthdirect on 1800 022 222 at any time to speak to a registered nurse (known as NURSE-ON-CALL in Victoria) for more information and advice.

For more information about the causes, diagnosis and management of Achilles heel injuries, visit Sports Medicine Australia.