Everything You Need to Know About Achilles Injuries
The Achilles tendon is the largest and thickest tendon the human body. It is required to do a lot of work whenever we are on our feet. During running and jumping the loads on this tendon can reach twelve and a half times our body weight. This high work load contributes to injuries in this tendon for athletes and regular folks alike. The Achilles Tendon is the most likely tendon in the human body to rupture and tendonitis is also quite common in runners and dancers. This is due to many reasons, but is usually related to overuse, mechanical overload, and susceptibility (such as getting older, or previous injury).

An injury to the Achilles tendon can occur at different places along the course of the tendon. There can be insertional tendinopathy, which means the injury is right where the tendon attaches to the heel, or calcaneus. In this case the inflammation and pain are usually caused by degeneration or breakdown of the tendon as it connects to the bone. This injury can be from overuse or overload, but also may be related to corticosteriod use, diabetes, hypertension, obesity, gout and the use of fluoroquinolone antibiotics. Usually the symptoms include pain and stiffness in the back of the heel which worsens with activity. Injuries can also occur along the course of the tendon between the heel and the calf muscles. There are different names for injuries in the tendon based on the actual place where the inflammation is detected. There can be more variability in symptoms along the tendon and can included pain, swelling, palpable nodule, or even no pain or swelling. Age related changes to the striation of the tendon is the main cause for non insertional tendinopathy.

Treatment of tendinopathy in the Achilles is usually conservative. Both insertional and non insertional respond best to a course of rest, compression, ice and activity modifications. Often NSAIDs, orthotics or a heel wedge can be prescribed to decrease pain. Surgery is not usually deemed necessary but when indicated it involves debridement of the thickened and inflamed tissue. This research paper states there is no evidence to support a local corticosteroid injection, and in fact they have been shown to compromise tendon health and should be avoided.

The Achilles tendon can also rupture (partially or completely tear). Ninety to one hundred percent of these injuries occur during forceful and sometimes unexpected change of direction, usually during some athletic move that involves pushing off from the involved foot. Other sudden impacts such as stepping into a hole or falling from a height can also cause rupture of the Achilles. The location of the tear is usually a few centimeters from the attachment on the heel. This is due to a weak spot related to blood supply in the tendon. Ruptures have become more common in the past twenty years and the mean age for this injury ranges from thirty seven to forty three and a half years. In the U.S. more than half of all these injuries happen in basketball and racquetball sports. Symptoms usually include a sudden snap felt in the heel area followed by difficulty standing on the injured foot.

Treatment for an Achilles rupture is controversial and both operative and non-operative options can be successful but have their own advantages and disadvantages. Treatment without surgery generally involves immobilization and non weight bearing for a period of several weeks. Then the patient is transitioned to weight bearing but is still using some type of immobilization cast or a functional brace. The functional brace is able to have the angle changed to gradually increase ankle motion. Although non surgical treatment is gaining popularity a rupture is often treated with surgery to repair the tear. After surgery there are also several protocol options including some time immobilized and then gradual return to weight bearing and range of motion for the ankle.
References
Uquillas, Carlos, MD. et al. Everything Achilles: Knowledge Update and Current Concepts in Management. In The Journal of Bone and Joint Surgery. July 2015. Vol. 97-A. No. 14. Pp. 1187-1195.