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: a complete or partial tear that occurs when the tendon is stretched beyond its capacity.
• Achilles tendinopathy: a chronic (long-term) condition that causes weakness and degeneration of the Achilles due to a series of very small tears (tendinosis).

What are the symptoms of Achilles tendon injuries?

The symptoms of Achilles tendinopathy include:

• 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 the 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 problem.

What causes Achilles tendon injuries?

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

• a sudden increase in physical activity or less recovery time between activity
• wearing unsupportive shoes
• running on hard or uneven surfaces
• tight or weak calf muscles
• inadequate warm up

Achilles tendon rupture can be due to:

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

Achilles tendon ruptures are common and typically occur in people who play high-energy sport on the weekend.

How are Achilles tendon injuries diagnosed?

If you have a problem with your Achilles, it is a good idea to see your doctor or physiotherapist.

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

How are Achilles tendon injuries treated?

If you think you may have hurt your Achilles, it is a good idea to stop any activity and carry out RICER — Rest, Ice, Compression, Elevation and Referral for treatment — for 2 to 3 days.

Pain relief such as paracetamol can help, if necessary.

Most acute and degenerative Achilles tendon injuries can be treated with non-surgical treatment.

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

• keep your weight off your ankle (such as by using crutches)
• do stretching and strengthening exercises
• tape your foot and heel
• use orthotics (firm inserts placed into a shoe)

If your Achilles is completely torn, surgery may be needed to repair it. This may reduce the chance that it will rupture again.

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

For more information, visit the Sports Medicine Australia website.

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