What causes Achilles tendon pain?

The Achilles tendon links the bone of the heel to the ankle back of the calf muscles. Pain in this tendon can result from tendon tear or rupture, or tendinitis, which can also be referred to by doctors as tendinosis or tendinopathy.

The Achilles tendon is a collection of strong fibers during movement supporting the calf and ankle. Since the Achilles tendon is important for walking, running , and jumping, wear and tear are very sensitive. Injuries to this tendon tend to be uncomfortable, and can limit the movement of a person.

We address the causes of Achilles tendon pain in this post, and when to see a doctor. Diagnosis, diagnosis, and prevention are all provided.

Causes

A tear or rupture to the tendon and tendinitis are the two main causes of Achilles tendon pain. Those two triggers are discussed below:

Tear or rupture

A tear or rupture can cause Achilles tendon pain
A tear or rupture can cause Achilles tendon pain

An individual can tear the fibers of an Achilles tendon. This type of injury could be either:

  • a partial tear, where some of the fibers remain intact
  • a complete tear, where the tendon ruptures and all the fibers become disconnected

A tear or rupture on the ankle and feet is typically the result of excessive or repetitive stress. People who play sports that require quick movement or direction changes, such as tennis, soccer and football, often suffer Achilles tendon injuries.

Also, these kinds of injury are more likely when a person starts a new sport first or returns to an activity after a prolonged break. Sudden increases in intensity of exercise can also result in Achilles tendon injury.

Symptoms of a tear or rupture can include:

  • a popping or snapping sound at the time of the injury
  • pain in the heel or back of the leg
  • pain that worsens when moving the ankle or foot
  • swelling around the heel
  • stiffness in the legs and heel
  • difficulty walking or moving the foot

Achilles tendinitis

Achilles tendinitis is a condition in which it inflames the tendon. There are two principal types:

  • Noninsertional Achilles tendinitis. This is where the fibers in the middle of the tendon become inflamed. This condition is more common in younger people.
  • Insertional Achilles tendinitis. In this type, the inflammation affects the fibers in the lower tendon. It can occur in anyone but often results from intense physical activity over several years, such as long-distance running.

Typically, all forms of Achilles tendinitis are due to overuse of the tendon, rather than a serious injury. Tendinitis may progressively develop over time when a person places too much strain on the tendon on a regular basis.

Risk factors for developing Achilles tendinitis can include:

  • sudden changes in a person’s activity levels or the intensity or type of activity
  • using inappropriate footwear, such as running in flat shoes
  • frequent or excessive activity
  • exercising on uneven surfaces
  • older age
  • being overweight
  • insufficient muscle strength in the lower legs
  • foot abnormalities, such as flat feet
  • taking fluoroquinolones, which are a type of antibiotic

Symptoms of Achilles tendinitis can include:

  • pain and stiffness in the ankle and legs
  • pain that worsens when moving the foot or ankle
  • swelling at the back of the ankle
  • bone spurs, which are bony growths near the heel bone

When to see a doctor

Partial Achilles tendon tears may not need medical treatment. If the symptoms are mild, then with enough rest, the injury can heal itself. It is however advisable to see a doctor for severe pain or injury that disrupts the normal daily functioning of a person.

Those who hear a sound that pops or clicks when the injury happens will see a doctor immediately.

Diagnosis

A doctor may request an X-ray to help make a diagnosis.
A doctor may request an X-ray to help make a diagnosis.

Usually, a doctor would start by talking about symptoms and examining a person’s medical history. Usually they will then conduct a physical test of the affected leg.

Symptoms of Achilles tendon issues can correlate with other forms of injury, such as a sprained ankle, which may make the diagnosis complicated for doctors.

A doctor may recommend an X-ray or MRI scan to aid in their diagnosis. These tests produce an image of the bones, ligaments and tendons and allow the doctor to check for problems, such as tears or inflammation.

Treatment

The form and severity of the injury depends on the treatment for Achilles tendon pain.

Treatment usually includes, for people with minor injuries:

  • resting the foot and ankle while the tendon heals
  • applying an icepack or cold compress on the tendon for up to 20 minutes several times a day
  • taking over-the-counter pain relievers, such as ibuprofen and acetaminophen

A doctor can also prescribe physical therapy to assist in strengthening the calf muscle, reducing tendon pain, and improving recovery.

Eccentric strength training, for example , is an important way of treating Achilles tendon injuries. These exercises involve simultaneous lengthening and straining of the Achilles tendon.

At first, doing those exercises with the aid of a physical therapist is necessary for a person. With practice, however, the exercises can be continued at home without supervision.

Another treatment choice for Achilles tendon pain is to wear supportive footwear, such as specially made walking boots or orthopedic shoes. Existing footwear can also be adapted, for example, by using heel lifts.

However with effective treatment, symptoms can take 3 to 6 months to disappear.

A doctor can prescribe surgery if the symptoms get worse or don’t improve. A surgeon can lengthen the muscles of the calf, or remove damaged tendon parts. The type of surgical procedure will depend on the nature of an injury to a person.

Less commonly, before recommending surgery, a doctor may prescribe steroidal injections or an extracorporeal shockwave therapy. Evidence also suggests that platelet-rich plasma injection in humans with Achilles tendinopathy can help improve healing.

Prevention

Warming up before exercise can help reduce the risk of injury to the Achilles tendon.
Warming up before exercise can help reduce the risk of injury to the Achilles tendon.

It’s not always possible to avoid an Achilles tendon pain.

The following tips can however help a person reduce the risk of injuring their Achilles tendon:

  • staying in good physical shape
  • avoiding sudden changes in exercise intensity or regime
  • building up exercise intensity gradually
  • warming up properly before exercising
  • wearing appropriate footwear
  • avoiding exercising or training on uneven surfaces or hard surfaces such as concrete

Summary

Achilles tendon pain can include tendinitis of the Achilles, and tendon tears or ruptures. These disorders are common in people who play sports and are usually caused by excessive calf muscle usage, but can also be caused by acute injury.

Factors that may raise the risk of an Achilles tendon injury for a person include abrupt changes in the form or level of physical exercise, inadequate footwear, or overweight.

People who notice a sound popping or snapping when the injury occurs should seek immediate medical treatment. See a doctor for severe or ongoing tendon pain in Achilles, too.

For Achilles injuries treatment options include rest and physical therapy. A doctor may prescribe surgery for persons with more serious injuries.

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