Nature and Management of Achilles Tendon Injury

Achilles Tendon Injury

Achilles tendon injury (ATI) refers to the tear or rupture of the band of fibrous tissue located at the back of your lower leg. It’s a fairly common condition affecting mostly athletes. However, it can also happen to anyone even those who aren’t fond of engaging in rigorous physical activities.

According to the American Orthopaedic Foot and Ankle Society, there are about 5.5-9.9 cases of Achilles tendon rupture for every 100,000 North Americans thus making it the most common injury affecting tendons in the lower extremities. [1]

What happens with ATI?

The Achilles tendon, also known as the heel cord, is the largest tendon in your body. It connects the calf muscles to the bones of your heel. It allows you to tiptoe or point your toes upward or downward. Overstretching it can cause a partial or a complete tear, which occurs with movements such as sudden pivots, quickly speeding up, intense jumping or stepping into a hole. The rupture happens usually about 2-2 ½ inches above the heel bone.

What puts you at risk?

  • Age and Sex. Like other parts of your body, the Achilles tendon can grow weak as you get older, degenerating and becoming thinner over time. The incidence is highest for adults between 30 and 40 years old. Also, men are five times more likely to suffer from ATI than women.

  • Wearing high heels. There are numerous downsides to walking in that stiletto for hours every day and this is one of them. Because you’re basically tip-toeing, there’s added strain and stress to your tendon.

  • Playing sports. Basketball, gymnastics, running, and tennis force you to move abruptly and the sudden action may ‘shock’ your tendon and stretch it beyond its limit. For example, when starting a sprint, you tend to push off your foot. That might result in ATI.

  • Medications. Steroid injections and some antibiotics like fluoroquinolones may weaken the tendon and therefore increase the risk for ATI.

  • Obesity. Like wearing high heels, supporting too much weight might be too much for the tendon to handle.

[su_note note_color=”#efefef”]Also Read: Tips to Prevent Repetitive Strain Injury of Hands and Fingers[/su_note]

How to prevent ATI?

  • Don’t push yourself too hard when doing sports. Keep in mind that although it’s the biggest tendon in your lower extremity, it still doesn’t take much to injure it. Even falling or stumbling can tear your Achilles tendon.

  • Stay active but avoid activities that add strain to the tendon. If you enjoy running uphill, you might want to reconsider just running around the park or neighborhood or building up your hill work gradually.

  • Choose better shoes. If you’re required to wear heels at work, buy those with better support. Rest and stretch your feet and legs as much as you can.

What are the common causes of ATI?

Whether it’s the abrupt rise in intensity of your workout or accidental trip, you can end up overstretching your tendon. The rule of thumb is any activity or movement that gives your tendon more stress than it can handle can cause ATI.

What are the signs and symptoms of ATI?

  • Popping or snapping sound when the tendon tears

  • Swelling or bruising

  • Pain above or near the heel. This may be mild initially, you’ll know when the tendon ruptures because the pain is sudden and severe as if someone kicked you in the calf

  • Stiffness, tenderness or weakness

  • Difficulty bending or pointing the toes

  • Standing on or pushing off your toes is impossible

What’s the first aid treatment for ATI? Remember RICE:

  • Rest the injured leg and use crutches as needed.

  • Ice – apply it to the affected area. Do this for about 20 minutes each time.

  • Compress the injured part by wrapping it with a compression bandage to mitigate swelling. However, make sure it’s not too tight to avoid impeding blood flow.

  • Elevate the leg using a pillow or any cushion. This also helps with the swelling since it allows the blood and fluid to drain by gravity.

Take over-the-counter pain medications but make sure to inform your doctor and read the instructions carefully. To help you with your mobility, you can also use scooters for leg injuries. Unlike crutches, a scooter can help you move about without occupying your hands.

What happens after undergoing treatment?

Your physician will most likely recommend stretching exercises you can do at home to strengthen your Achilles tendon and calf muscles. Functional rehabilitation helps you to return to your normal activities. Some may take 4-6 months while others can go for a year.

Achilles tendon injuries are quite common but still serious all the same. Treatment will depend on the severity of the tear or rupture and there are pros and cons for both surgical and non-surgical procedures. Either way, the earlier the medical intervention, the better.


[1] Kane, J., MD. (2015, July). Achilles Tendon Rupture. Retrieved December 28, 2017, from