The Achilles tendon connects the heel bone to the calf muscles and it is comprised of a fibrous tissue. Throughout the whole body, this tendon is the strongest and largest. However, it is also among the most vulnerable structures in the body since it has constant and high tension placed on it and the blood supply is limited. It is important for all people to understand the injuries that might affect this tendon and what can be done to protect it and promote healing.
This is a type of overuse injury that is relatively common. In the worst-case scenario, the Achilles tendon may rupture, but no matter the severity of the injury, it can cause a wealth of discomfort that can make it difficult to walk. This condition occurs when the tendon becomes inflamed. When this tendon is stiff and lacks flexibility, this increases the risk of this type of injury. Other causes and risk factors may include:
- Achilles tendon overuse
- Poor exercise or training technique
- Exercising or training on surfaces that are sloped or hard
- Wearing inappropriate footwear while exercising or training
- Sudden or major exercise or training program changes
- Taking fluoroquinolone antibiotics
- Having psoriatic arthritis or ankylosing spondylitis
- Having high cholesterol, diabetes or high blood pressure
The hallmark symptom is morning pain. This pain is localized to the area of the injured tendon and the immediate area around it. People may also experience pain and swelling. The pain can come and go. For example, before your run, you may notice pain that lessens as you keep running. Then, once your run is over, the pain can increase again. The outline of the tendon may have subtle changes with some thickening as well. Applying pressure to the injured area may cause pain because it tends to be sensitive. In many cases, the damage is severe when this tendon is involved. In fact, full recovery may take as long as a year or two.
Preventing Achilles Tendinopathy
It is not always possible to fully eliminate your risk of this injury, but there are things you can do to help reduce your risk. These include:
- Gradually increase your level of activity to reduce the strain put on this tendon.
- Be mindful of the shoes that you wear. They should have firm arch support and sufficient cushioning to absorb shock. Heel lifts may also reduce the stress on this tendon. Replace your shoes regularly since worn out shoes increase the risk of injury.
- Work on strengthening your calf muscles so that they are able to better cope with the stress from exercise and activity.
- Make sure to fully warm up before engaging in strenuous activity and immediately stop if you experience any pain.
- Every day make sure to stretch regularly to promote greater flexibility of this tendon and the surrounding tissues.
- Consider cross-training so that you get your desired activity level without as much stress on the tendon. For example, instead of always running, alternate this with swimming, cycling, and other low-impact activities.
Options to Promote Healing
It is important to see your doctor if you believe that you have injured this tendon. In some cases, surgery might be necessary to repair the damage, especially if a rupture occurred. However, in addition to medical treatments, there are other methods your doctor might also recommend to promote healing.
Stretching is among the most important methods for healing this injury and helping to prevent it. A proper stretching routine can:
- Reduce the risk of tendon injury
- Decrease muscle tension and soreness
- Increase tissue suppleness
To reap the benefits of stretching, however, it is important that you are doing each stretch properly. First and foremost, warm up before you start stretching. By warming up first, you are making sure that your muscles have sufficient oxygen while ensuring that they have optimal flexibility. A warm-up of five to 10 minutes is adequate. Ideal activities include jumping jacks, a brisk walk, walking lunges, and cycling.
Once you are ready to stretch, start with a calf stretch for this tendon. Face a wall and lean into it. Place one leg in front of you and bend at the knee and put the opposite leg slightly behind you keeping the knee straight. Push your hips forward and you should feel the stretch in your calf muscle.
Another ideal stretch for this tendon is the bilateral heel drop. Stand on a step with the back half of your feet hanging off. Allow your heels to lower until you feel the stretch in your calf muscles. Make sure that you have something to hold onto and that this stretch is controlled.
Other tips for effective stretching include:
- Never bounce when you are stretching
- Hold your stretches for 10 to 30 seconds
- If you experience discomfort, immediately stop the stretch
Your shoes are another important part of the puzzle. The soles should be non-skid and flat to reduce the risk of falls and to keep your feet and legs neutral. Consider the activity you will be doing and look for shoes that are made for it. For example, climbing shoes and running shoes are very different. Other tips include:
- Ensure the shoe works with your foot’s unique contours and traits, including pronation
- Make sure the shoe fits well by getting measured later in the day when your foot is naturally slightly larger
- Wear the socks you plan to wear with the shoes when trying them on
- Replace your shoes when they start to show wear. The general recommendation is 45 to 60 hours with activities, such as aerobic dance, basketball and tennis, and 300 to 500 miles of walking or running.
Using ice, resting the injured tendon, elevating it an applying compression can also be beneficial following an injury.
In addition to this information, talk to your doctor about healing Achilles’ tendon injuries or preventing them in the first place. While this is especially important for athletes and very active people, everyone is at risk for an injury to this tendon.