Last Updated February 20th, 2019
What Is The Achilles Tendon?
The role of connective tissues is to provide the glue that binds together the various other types of tissues, organs and structures in the body. Tendons are a form of connective tissue. They are tough bands of fibrous connective tissue that help to link together muscles and bones. The Achilles tendon or the calcaneal tendon is the one that connects the calf muscles to the heel bone in the foot. In fact, it is the largest such tendon in the human body.
Run your fingers along the back of your foot and lower leg, and you will be able to clearly feel this tough but flexible band of tissue. The interface between this tendon and the calcaneus or heel bone is cushioned by a lubricating structure known as a bursa. One of the functions of the Achilles tendon is to enable you to point your feet. This posture is called plantar flexion.
What Are Achilles Tendon Injuries?
When you walk, run or jump, there is a great deal of stress being placed upon the Achilles tendon.
When this pressure becomes excessive, or as a result of enduring stress over a longer term, the Achilles tendon may become weakened and develop ruptures or even outright tears. Athletes, in particular, must take care to avoid such injuries.
However, it can happen to others too as a result of accidental injuries or when one attempts a physically strenuous activity without adequately conditioning the body first. In fact, even the habit of wearing high heels on a regular basis puts you at risk of hurting your Achilles tendon. Such injuries are common and sometimes the resultant pain can be quite severe. If you have such an injury, seek medical help immediately.
What Causes Achilles Tendon Injuries?
Generally, there is a tendency to injure the Achilles tendon when you put great stress on it. Gymnasts, marathon runners, sprinters, dancers, and sportsmen and women in particular are prone to developing this kind of injury. This is because their movements often speed up or slow down suddenly, there may be sudden jumps and harsh landings and there may even be quick turns. All of these actions put pressure on the Achilles tendon and can weaken or even damage it.
Even if you aren’t an athlete, dancer or sportsman, you should take care to properly warm up your body before attempting advanced physical exercise. It’s always best to work up strength, flexibility and endurance step by step and give your body some time to adapt to the exercise. Inadequate conditioning before taking on challenging physical activities is the perfect recipe for injuries.
Additionally, if you are accustomed to wearing high heels, this can be a risk factor for Achilles tendon injuries too. Wearing high heels for long stretches of time on a daily basis is proven to raise the risk of developing lower back pain, heel pain, foot deformities such as bunions or conditions such as metatarsalgia. Heeled footwear forces your feet and your spine into an unnatural posture, disturbing the normal distribution of weight. As a result, there is additional stress being placed on your Achilles tendon as well.
Those who are flat footed also have a greater risk of developing such injuries. Again, this has to do with the distribution of weight. The natural arches in the soles of our feet help to support and distribute the weight of our bodies in a healthy manner. Those with fallen arches or flat feet do not have this feature; hence, there is a greater than normal likelihood of developing injuries.
Sometimes steroid injections administered to the lower leg, particularly the ankle, can end up weakening the Achilles tendon, increasing the risk of ruptures. In other cases, age-related degeneration can also weaken the tendon enough to give way under stress.
What Does It Feel Like?
A rupture in the Achilles tendon may be described as either partial or complete. Either kind can be painful. The pain is felt in the area above your heel. You may notice that it is more intense when you point your feet or stand on your tiptoes. There may be some amount of bruising, swelling, tenderness and stiffness. Similar symptoms may be noticed when you have inflammation in the Achilles tendon. That condition is known as tendinitis and although it can be painful and uncomfortable, the pain is typically less severe as compared to that of a rupture or tear in the tendon.
Sometimes, the tendon ruptures or tears with an audible snap and sudden, sharp burst of pain. Most likely, you will be unable to put weight on the leg that has been injured. You will be unable to walk normally. In fact, it is best not to put any weight on that leg since that will only make your injury worse. It is quite possible, though, that you may have no noticeable pain at the time that the injury occurs.
What Should Be Done About It?
As soon as you notice the injury or the pain, find a comfortable position and take care not to put any pressure or weight on the injured area. Seek help to get to a hospital or an orthopaedic surgeon as soon as possible, especially if you have developed a complete rupture. The doctor or surgeon will be better able to diagnose the nature of the injury if you can recall and describe exactly how and when it occurred.
A physical examination may be followed by imaging tests in order to visualise the extent of the damage. Depending on the extent of the injury and other parameters such as the general health condition and age of the patient, the patient may undergo either surgical or non-surgical treatment, Surgery for the repair of the Achilles tendon involves sewing its ruptured ends together. Alternatively, the patient may need a tissue graft.
Following surgery, the patient will require to wear a brace or use crutches to keep weight off the injured leg. Physiotherapy is recommended for rehabilitation. Full recovery tends to take about six weeks or more. Athletes and sportsmen may be advised to rest and not return to their game for anywhere between 6 months and a year depending on the rate of recovery.
Should I Be Concerned About Complications?
As with any injury and surgical procedure, there is always the risk that the injury may not heal sufficiently or that infections may develop at the site. Once you have suffered a rupture in the Achilles tendon, there is a higher risk of it recurring. In fact, patients who have opted for conservative treatment face a greater risk of a repeat injury as compared to those who opt for surgical repair. There is also the risk of a blood clot forming at the site of the injury.
Achilles tendon injuries are common, particularly among sportsmen. If you are a professional athlete, gymnast or sportsperson, you should remain aware of the risks and train accordingly. Do not suddenly intensify your game or your performance without first preparing your body for it. Inclusion of a warm-up slot before exercising which mainly focuses of stretching the calf muscles, always easing into a new exercising regime instead of suddenly intensifying it and choosing proper footwear which markedly cushions the heel and arch-support, can all be profoundly effective in keeping this malady at bay. Combining high and low impact activities such as tennis and swimming can also reduce the continued stress on the tendons and further prevent the tendinitis. In case of reducing the heel height of shoes, decreasing the height gradually is the logical method for preventing Achilles Tendinitis.
- Three-quarters of all Achilles tendonitis injuries are caused during sporting activities, mostly the ones which require repetitive jumping and running.
- 1 out of every 4 cases of Achilles tendonitis requires surgery. 20% of these individuals require a repeat surgery.
- Bone growth occurs in case of Insertional Achilles tendonitis. This occurs at the point where the tendon attaches itself to the heel.
- Exercising/ playing outdoor sports in cold climates or hilly areas also increase the likelihood of damaging the Achilles tendon.
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Dos and Don'ts
- Apply the RICER protocol – rest, ice, compression, elevation, and referral for 48-72 hours post injury.
- Always perform stretching up exercises before beginning your exercise routine. It is important to warm up and cool down properly to avoid sudden jerks to the feet.
- Use orthotic insoles which provide proper cushioning to the feet.
- Continue any physical activity that puts a strain the damaged Achilles tendon. Never run /play through the pain.
- Delay the treatment for the condition. Seek immediate medical help as soon as the pain develops to avoid further wear and tear.
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