Welcome to Somersworth Physical Therapy’s patient resource about Achilles Tendon Problems.
Problems that affect the Achilles tendon include tendonitis, tendinopathy, tendocalcaneal bursitis, and tendonosis. Each of these conditions will be described and explained. These problems affect athletes most often, especially runners, basketball players, and anyone engaged in jumping sports. They are also common among both active and sedentary (inactive) middle-aged adults. These problems cause pain at the back of the calf. Severe cases may result in a rupture of the Achilles tendon.
This guide will help you understand:
- where the Achilles tendon is located
- what kinds of Achilles tendon problems there are
- how an injured Achilles tendon causes problems
- what treatment options are available
Where is the Achilles tendon, and what does it do?
The Achilles tendon is a strong, fibrous band that connects the calf muscle to the heel. The calf is actually formed by two muscles, the underlying soleus and the thick outer gastrocnemius. Together, they form the gastroc-soleus muscle group.
Gastroc-Soleus Muscle Group
When they contract, they pull on the Achilles tendon, causing your foot to point down and helping you rise on your toes. This powerful muscle group helps when you sprint, jump, or climb. Several different problems can occur that affect the Achilles tendon, some rather minor and some quite severe.
Powerful Muscle Group
A bursa is a fluid-filled sac designed to limit friction between rubbing parts. These sacs, or bursae, are found in many places in the body. When a bursa becomes inflamed, the condition is called bursitis. Tendocalcaneal Bursitis is an inflammation in the bursa behind the heel bone. This bursa normally limits friction where the thick fibrous Achilles tendon that runs down the back of the calf glides up and down behind the heel.
A violent strain can cause trauma to the calf muscles or the Achilles tendon. Sometimes this is referred to as tendonitis. This injury can happen during a strong contraction of the muscle, as when running or sprinting. Landing on the ground after a jump can force the foot upward, also causing injury. The strain can affect different portions of the muscles or tendon. For instance,
the strain may occur in the center of the muscle. Or it may happen where the muscles join the Achilles tendon (called the musculotendinous junction).
Chronic overuse may contribute to changes in the Achilles tendon as well, leading to degeneration and thickening of the tendon. Studies show there is no sign of inflammation with overuse injuries of tendons. Most experts now refer to this condition as tendinopathy or tendonosis instead of tendonitis.
Achilles Tendon Rupture
In severe cases, the force of a violent strain may even rupture the tendon. The classic example is a middle-aged tennis player or weekend warrior who places too much stress on the tendon and experiences a tearing of the tendon. In some instances, the rupture may be preceded by a period of tendonitis, which renders the tendon weaker than normal.
How do these problems develop?
It’s not entirely clear why these problems develop in some people but not in others. Changes in the normal alignment of the foot and leg may be part of the problem. Anyone with one leg shorter than the other is at increased risk of Achilles tendon problems.
For the athlete, sudden increases in training may be a key factor. Runners may add on miles or engage in excessive hill training while other athletes increase training intensity. Other risk factors include obesity, diabetes (or other endocrine disorders), aging, exposure to steroids, and taking fluoroquinolones (antibiotics).
Problems with the Achilles tendon seem to occur in different ways. Initially, irritation of the outer covering of the tendon, called the paratenon, causes paratendonitis. Paratendonitis is simply inflammation around the tendon. Inflammation of the tendocalcaneal bursa (described above) may also be present with paratendonitis. Either of these conditions may be due to repeated overuse or ill-fitting shoes that rub on the tendon or bursa.
As we age, our tendons can degenerate. Degeneration means that wear and tear occurs in the tendon over time and leads to a situation where the tendon is weaker than normal. Degeneration in a tendon usually shows up as a loss of the normal arrangement of the fibers of the tendon. Tendons are made up of strands of a material called collagen. (Think of a tendon as similar to a nylon rope and the strands of collagen as the nylon strands.)
Some of the individual strands of the tendon become jumbled due to the degeneration, other fibers break, and the tendon loses strength.
The healing process in the tendon causes the tendon to become thickened as scar tissue tries to repair the tendon. This process can continue to the extent that a nodule forms within the tendon. This degenerative condition without inflammation is called tendonosis. The area of tendonosis in the tendon is weaker than normal tendon. Tiny tears in the tissue around the tendon occur with overuse. The weakened, degenerative tendon sets the stage for the possibility of actual rupture of the Achilles tendon.
What do these conditions feel like?
Tendocalcaneal bursitis usually begins with pain and irritation at the back of the heel. There may be visible redness and swelling in the area. The back of the shoe may further irritate the condition, making it difficult to tolerate shoe wear.
Achilles tendonitis usually occurs further up the leg, just above the heel bone itself. The Achilles tendon in this area may be noticeably thickened and tender to the touch. Pain is present with walking, especially when pushing off on the toes.
An Achilles tendon rupture is usually an unmistakable event. Some bystanders may report actually hearing the snap, and the victim of a rupture usually describes a sensation similar to being violently kicked in the calf. Following rupture the calf may swell, and the injured person usually can’t rise on his toes.
How do health care providers identify the problem?
Diagnosis of Achilles tendon problems is almost always made through clinical history and physical examination. The physical examination is used to determine specifically where your leg hurts.
When you visit Somersworth Physical Therapy, our Physical Therapist may perform some simple tests if a rupture is suspected. Your therapist may move your ankle in different positions and ask you to hold your foot against applied pressure. Palpation (feeling for any abnormalities in the tendon) and muscle function tests may also be included. By stretching the calf muscles and feeling where these muscles attach onto the Achilles tendon, we can begin to locate the problem area.
Call Somersworth Physical Therapy (603-841-5441) and ask about a FREE Discovery session to help determine what is causing your Foot and Heel Pain.