What type of Achilles Injury Do You Have?

When discussing injuries that can hamper your day-to-day life, an achilles injury can be one of the most debilitating. The achilles tendon is the largest and strongest tendon in your entire body. Seeing as how it is involved in every step you take, having any level of injury to that vital tendon can be a slight nuisance at best, and a crippling issue at worst. It's also a very big pain when it comes to recovery if not handled with care, as the area around the ankle will tend to heal slower than other areas of the body due to blood flow amount. So, what can you do if you've noticed pain in your achilles tendon? That's what we hope to address today.

The first thing to do is determine what kind of achilles issue you are dealing with. Achilles pain can often be diagnosed with a combination of physical examination. One of the most common diagnoses you can have with an achilles is a strain, a rupture, and tendonitis. The first we will discuss is the last one.

Achilles tendonitis is a specific condition of the achilles based around inflammation. According to MSK Doctors, achilles tendonitis refers specifically to inflammation of the tendon. Initial symptoms typically include swelling, stiffness, and tenderness along the tendon, particularly when moving the foot or ankle. Tendonitis is usually caused by overuse and/or repetitive stressing of the tendon. Pain will often reside around or near the insertion point at the heel. Gradual symptoms can include pain and stiffness after long periods of inactivity. Some of the most common culprits include repetitive stress from activities like running, jumping, or walking, especially on hard surfaces. Other contributing factors include tight calf muscles, flat feet, and improper footwear.

In a similar vain to tendonitis, we have achilles tendinopathy. While tendonitis deals with pain and inflammation of the tendon, tendinopathy deals with the degeneration of the tendon's collagen fibers. Physiotherapists state that these micro-tears in the fibers are often caused by overexertion or repetitive strain on the tendon through running or jumping activities. This condition points to a tissue disorder, namely repetitive damage to the tendon, which fails to heal adequately. Achilles tendinopathy is considered a more chronic condition that may require the use of more intensive treatment. Per Mayo Clinic, it is an umbrella term for conditions affecting the tendon. It often occurs in runners who have suddenly increased how hard or long they run. It's also common in middle-aged people who play sports, such as tennis or basketball. For both of these conditions, understanding the causes and symptoms can be crucial to prevention.

Next, we will discuss an achilles strain. Much like any other strain, this will likely be the result of heavy increases in physical activity, not properly warming up before a workout, improper footwear choice, or even simply tight calf muscles. This will result in micro-tears in the tendon fibers. According to experts at The Cleveland Clinic, there are 2 forms of achilles tendonitis: Insertional and Non-insertional. With non-insertional, the fibers in the middle of your tendon start to break down, swell and thicken. This type of Achilles tendinitis affects people who are more active. With insertional, the lower part of your heel is affected, where the tendon connects, or inserts, to your heel bone. It can affect anyone, even people who aren’t active. But it most commonly affects people who overuse the tendon, such as long-distance runners. They also state that roughly 24% of athletes will likely experience some form of achilles injury in their lifetime.

Symptoms of achilles strains include things like pain in the ankle/heel area, swelling around the area, weakness in the leg, pain when walking, pain when raising your heel off the ground, and stiffness in the heel/ankle area. To take care of a strain, there are several options to consider. The RICE method is an easy first choice: rest, ice, compression, elevation. You'll also want to avoid situations which will work your achilles tendon as much as you can, such as walking steep inclines, or going up large amounts of stairs. Supportive shoe orthotics like heel lifts can also be helpful, or even a medical boot if severity calls for it. Anti-inflammatory drugs such as ibuprofen can help with pain and swelling. If standard simple home treatment like this is ineffective, the next best step is to speak to a medical professional about the issue. Your healthcare provider will first recommend nonsurgical treatment. It may take a few months for the pain to get better — especially if you’ve already had symptoms for a few months.

The worst-case scenario for an achilles injury is a rupture of the tendon. According to The Cleveland Clinic, an Achilles tendon rupture is a full or partial tear of the Achilles tendon. This acute (sudden) injury occurs when the tendon stretches to its breaking point. It happens most frequently while playing sports. Tripping, falling or twisting your ankle can also cause an Achilles tear. It is an injury which most commonly occurs in people between the ages 30-40, but can happen to anyone if the tendon is put under enough stress. The tear typically occurs during moments of high physical demand, such as playing sports; although it can be torn outside of these situations, such as mis-stepping on stairs, twisting your ankle, etc. The Cleveland clinic also notes that some medications — including certain antibiotics and steroid injections in the area — can weaken the Achilles tendon. This can put you at a higher risk for a tear.

Symptoms of an achilles tendon tear include sudden intense pain in the heel area, swelling/bruising in the heel and ankle, consistent pain when stepping, and noticeable tenderness in the area. Treatment for a tendon rupture should begin immediately with the RICE method to quell immediate swelling and discomfort as much as possible. You should also seek an examination with a healthcare professional to help accurately determine the severity of the injury. Your healthcare provider will physically examine your foot and ankle. They’ll check your ability to move it in various directions and see how you react to pressure on the area. They will also feel for a gap in the tendon that suggests it’s torn. They may also decide to have you undergo forms of medical imaging such as an MRI or Ultrasound. Depending on the severity of the injury, your healthcare provider may suggest surgery. Most providers recommend surgical repair of a torn Achilles tendon in people who are active and middle-aged or younger. During surgery, a surgeon stitches the two ends of the torn tendon back together. After surgery, you’ll need a cast on your lower leg to immobilize the tendon while it heals. Having surgery to repair a torn Achilles tendon is usually the best option for younger, active people. After surgical repair, you can regain your Achilles tendon’s full strength and function.