The Achilles tendon is the thickest and strongest tendon within the body, although occasionally it is exposed to stresses which make it susceptible to injury. Injuries to the Achilles tendon commonly occur when forces placed on the tendon exceed its tensile limits. The Achilles tendon is a strong fibrous core that connects the gastrocnemius and soleus muscles to the calcaneal tuberosity.
The two most common types of injury to the Achilles tendon include Achilles tendonitis and Achilles tendon rupture. Tendonitis involving the Achilles tendon is painful and often debilitating. Chronic inflammation of the Achilles tendon is due to stresses, micro-tears, and is also a result of inflammation and scar formation. Achilles tendonitis may lead to pain in the back of the heel, occasional swelling due to thickening of the tendon and often occurs in athletes such as runners.
Rupture of the Achilles tendon can be either partial or complete. A rupture of the tendon may occur suddenly without warning or as a result of tendonitis. The patient will often feel or hear a pop in the ankle when the tendon ruptures. This is followed by the presence of sharp pain in the back of the ankle. As a result of the tendon rupturing the foot may become floppy and weak. Finally the patient feels as if they have been kicked in the back of the ankle where the tendon has ruptured.
What causes achilles tendonitis?
Common causes of injuries to the Achilles tendon include:
- Repetitive or sudden increases of stress placed on the tendon.
- An increase in exercise intensity.
- Not allowing recovery time between exercises.
- Decreased range of motion due to tightening of the calf muscles and bone spur which cause rubbing against the tendon.
Pain from Achilles tendonitis is localized to the back of the heel and the Achilles tendon. Sometimes painful regions develop on each side of the Achilles tendon. In severe cases, the tendon may become inflamed and swollen. The pain is usually worse in the morning and at the beginning of a run. It’s often times relieved with rest, but it may be constant. With a typical case of Achilles tendonitis, tighter regions of the soleus muscle refer pain to the Achilles tendon and heel. To self-correct the Achilles tendonitis, the soleus muscle and its fascia must be loosened.
Recognizing and treating Achilles tendonitis
Treatment of Achilles tendonitis includes: anti-inflammatory medications, physical therapy utilizing the active release technique, massage therapy, ice therapy, immobilization and injections. Techniques for injection often include prolotherapy, platelets and needling. Techniques for injections are performed with or without ultrasound guidance. However they are still within the investigative phase. It is advised not to inject steroid directly into the tendon. The goal of treating Achilles tendonitis is to reduce stress on the tendon. In rare of resisting cases, surgery is sometimes needed.
The Simmonds test is a clinical evaluation test used to assess the integrity of the Achilles tendon with the patient lying prone on the examination table, the examiner will squeeze the calf muscles of the affected leg. Slight plantarflexion of the ankle is a normal response to this examination when there is no presence of a rupture. However if the Achilles Tendon is ruptured, there is no plantarflexion or movement of the ankle in response to squeezing of the calf muscles.
Surgery is done by exposing the torn tendon through a incision in the skin. The ends of the tendon are cleaned and approximated. Once the tendon has been cleaned, repair of the ruptured tendon can be done. The Simmonds test is once again performed to check the integrity of the Achilles Tendon after repair. A cast or splint is used for 4 to 6 weeks post operatively then physical therapy is initiated.