Just mention Achilles tendon to a runner or a tennis player and you’ll see him or her squirm. The Achilles tendon attaches the ankle to the calf muscles and is critical for the push-off motion in walking, running and jumping. A sudden increase in activity, overuse of the lower leg muscles, or a direct blow or injury to the lower leg or foot can damage this tendon. 

Achilles tendon tears or ruptures are fairly common in middle-aged males, particularly those involved in sports such as basketball and racquet sports. When the tendon tears or ruptures, you generally feel a “pop,” as if you were hit in the back of the leg and can’t stand on your toes. People who don’t stretch their calves much, who have chronic Achilles pain or who have taken steroids (particularly injections for tendonitis and bursitis) are more susceptible to rupture.

Once injured, the Achilles tendon can take a long time to heal. It can take even longer if you don’t give the injury adequate healing time before returning to your activities.

Symptoms

The tendon feels bruised, stiff or sore, especially in the morning or the early part of a run. However, the Achilles tendon generally does not hurt for the majority of the run or activity, which may lead you to think the injury can’t be too bad. As the condition worsens, a burning sensation may develop, and, at this point, sports activity should stop. Unfortunately, people often continue and scar tissue develops within the tendon. Often partial tearing results in chronic swelling.

Other common conditions of the Achilles tendon include:

• Achilles paratendinosis. This is inflammation of the fatty covering of the Achilles tendon, which often results in diffuse swelling. In contrast to tendonitis, it usually gets worse with activity. Direct tendon massage, performing heel lifts and icing the area all seem to make paratendinosis worse. Calf (not tendon) massage, physical therapy and complete rest are the best remedies. It’s important to note that you can have both tendinosis and paratendinosis, particularly if you’ve ignored symptoms for more than a year.
• Heel spur (tendo-calcinosis). Any tendon or ligament can calcify when stressed. Your doctor may recommend surgery if typical tendonitis remedies don’t relieve symptoms. This is more likely if the calcification is fragmented and standing on your toes causes pain.
• “Pump bump.” High-heeled shoes (“pumps”) were once thought to cause a bony prominence on the heel bone, but in fact anyone with an irregularly shaped heel bone that “rocks and rolls” or who wears a hard heel cup in their shoe is susceptible.
• Bursitis. Bursitis is an inflammation of the sack or cushion that protects the bone from pressure. Padding can help. Surgery is less likely for bursitis than other Achilles-related conditions.

Treatments

Don’t fool yourself thinking you’re not seriously injured if your Achilles tendon doesn’t hurt while you exercise. Early treatment will minimize downtime and potential complications. Typical treatment includes:

• Rest
• Ice (5-10 minutes)
• Anti-inflammatory medications to relieve pain
• Stretching and strengthening exercises
• Physical and massage therapy
• Heel lift or orthotics to relieve the pressure on the tendon
• A walking boot to immobilize the tendon
• If needed, surgery to remove the inflamed tendon lining or degenerated tissue

How to Prevent Achilles Tendon Injury

• Warm up and stretch before activities
• Rest between activities
• Maintain conditioning such as ankle flexibility, muscle strength and endurance, and cardiovascular fitness
• Use proper technique for all activities
• Wear appropriate shoes

Range of Motion and Stretching Exercises

Start slow with these exercises, and progress until you feel a gentle stretching sensation. Each stretch should be held for 20 to 30 seconds. These exercises should not increase your pain, even the day after exercise.

Gastrocsoleus Stretch I

Stand facing a wall. Put your hands on the wall with the leg to be stretched behind you. With your toes pointing forward, lean toward the wall while keeping your heel on the floor. First, keep your knee straight. Then, bend the knee slightly.

Gastrocsoleus Stretch II

Place your toes and the ball of your foot on a book or the edge of a stair. Your heel should be off the ground. Hold on to a chair or stair rail for balance. Allow your body weight to stretch the calf and Achilles tendon. First, do this exercise with your knee straight. Then, bend the knee slightly and perform the exercise.

Plantar Flexor Strength I

Loop elastic band or towel around the bottom of your foot. Pull the band toward you. Push your toes away from you slowly. Hold for several seconds. Repeat several times.

Plantar Flexor Strength II

Stand on the edge of a step. With your body weight on the front of the foot, raise your position with your knee straight. Lower the heel of the injured side below the level of the step. Rise back up to the level of the step, using the uninjured leg if you need help. 

Work up to three sets of 15. You can advance this exercise by bending the knee of the injured leg slightly or by wearing a backpack with weights inside.