The largest tendon in the body, the Achilles tendon connects our calf muscles to our heel bones. Involved in walking, running, and jumping, the Achilles tendon is incredibly strong, but nevertheless is still vulnerable to injury and rupture. An Achilles tendon tear is a separation of the tendon’s fibers, which causes pain, discomfort, and an interruption to normal daily functioning. This article will detail the symptoms, causes, and care options for an Achilles tendon tear, as well as ways to prevent the injury or prevent its recurrence.
The Achilles tendon is named after the legendary figure Achilles. The myth of Achilles says that his mother Thetis was so concerned over her son’s mortality, she dipped him in the River Styx, whose waters supposedly leant the invulnerability of the gods. Her grip on Achilles was at his heel, and was so tight that the water never touched that part of him, making the heel of Achilles his only vulnerability.
You are using your Achilles tendon with every step you take, and though it’s a remarkably durable part of your body considering the strain it’s always under to perform, sometimes the tendon is stretched too far. In that instance your tendon might rupture or tear. Common causes for this injury include the following.
Your Achilles tendon allows you to push off from your heel and rise onto your toes when walking and jumping, and when a rupture or tear occurs it’s usually within 6 centimeters or 2.5 inches from where it attaches at your heel bone. Blood flow is notably poor in this area of the body, which not only makes it more prone to injury, but also means that it can take longer to fully heal.
Though everyone is technically at risk of tearing their achilles tendon (accidents can happen to anyone), there are some risk factors that make some more vulnerable to this injury than others.
Here are the Achilles tendon pain symptoms you may experience (which may also include Achilles heel pain and/or Achilles calf pain as this damage can affect the whole lower leg area). Some injuries may be minor, and some will require medical or surgical intervention, which we’ll discuss further on. First up, the signs of an Achilles tendon injury.
If you suspect an Achilles tendon injury, you should seek medical advice right away to avoid exacerbating or re-injuring the damaged area. Surgery is often needed to treat an Achilles tendon rupture or tear, but consult with your doctor on whether nonsurgical treatment is an option that can be tried first, as surgeries can be costly, risky, and unwelcome. Your doctor will most likely diagnose you with a physical exam, and perhaps an MRI imaging test to ascertain whether you’ve sustained a partial tear (meaning that some of the tendon is still intact and okay), or a full tear (which means the two ends of the tear are no longer attached).
Nonsurgical options for treatment of an Achilles tendon tear include placing the foot into a splint, cast, or cast-boot to hold it in the plantar flexion position (a pointed toe or tippy toe position). Nonsurgical healing may still take weeks or months to see the tendon fully repaired, and even so the area can remain vulnerable. This form of healing may be done with or without physiotherapy, but even these nonsurgical options should not be attempted lightly, or without medical consultation: these are possible options if one wishes to avoid surgery, but they may not ultimately do the trick if they’re not done properly. A doctor may want to avoid surgery depending on certain conditions in you, their patient, and may take into account the following risk factors for surgical intervention.
Surgical treatment may not be the best for everyone, but a conversation with your diagnosing physician and/or an orthopedic surgeon should be had to find your ideal solution.
During this surgery, the ends of the torn Achilles tendon will be exposed and sutured together to reattach them securely so that healing can take place. Surgeons are trained to make sure their sutures are neither too tight nor too loose, as either scenario might hamper recovery. Surgeons are also careful with the surrounding soft tissue of the area to avoid causing nerve damage or infection.
Surgical repair works best when it is performed sooner rather than later, before scar tissue can begin to form. Fortunately in recent years, these surgeries can be done with minimally invasive smaller cuts. Ask your surgeon how they are best prepared to perform the surgery (some will prefer larger incisions if it means a stronger suture), and make your own personal decision on what kind of surgeon/surgery your injury needs.
This is a more complicated surgery for a more serious condition, wherein the Achilles tendon has retracted into the leg and scarred into that shortened position. Restoring the tendon length is the aspect that makes this procedure more difficult, and its recovery longer.
The methods used to re-lengthen the tendon include a turndown procedure that folds down tissue from the top of the calf to add more length. Another method is transferring tendons from other areas of the ankle to bridge the gap. While these procedures for chronic Achilles tendon tears are often not as successful as the acute surgeries, they are nevertheless the best option in some cases to restore some functioning of the Achilles tendon.
Surgeons will frequently release their patients with walking boots or splints to help support the Achilles tendon as it heals and as the patient starts walking normally again (more at-risk patients may be given an immovable cast at first as well). The good thing is that movement can often begin immediately following surgery, so while patients will need protective gear as they recover, they are still encouraged to begin walking and moving, and in some cases physical therapy will be prescribed to help with safe stretches, quicker strengthening, and effective exercises. The timeline of recovery for most patients involves resuming regular walking in 4-6 weeks, recovering their strength in about 8 weeks, and returning to exercise after 3 months. Returning to sports, however, can take as long as 6 months, and sometimes longer depending on the severity of the injury.
During physical therapy people learn exercises and stretches to strengthen their calf muscles over time, to encourage recovery, and to prevent re-injury. These stretches will be slow (no bouncing or using too much force), and some of the calf exercises may come with the following recommendations for going forward in health and fitness.
Even once you heal, you still remain at a greater risk of re-injuring your Achilles tendon, so it’s also recommended that you stretch both before and after exercising, discontinue wearing any high-heeled shoes or boots, and as always ask your doctor for specific advice regarding what you can safely do (then take that advice to heart). The truth is that as we age our health becomes a more precious commodity, so whatever amount of use you regain after an Achilles tendon tear, treasure and protect that recovery, so that you can keep moving forward.