Achilles Tendon Pain

 

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At a Glance

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What is the Achilles Tendon?

The Achilles tendon (or heel cord) is the thick strap that can be felt running down the back of the calf into the heel. It connects the large calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus). When the Achilles tendon pulls on the heel, it makes us go up on tiptoe, or helps push us forward when walking or running. If this tendon is not working properly due to swelling or a tear, it can be painful, be difficult to walk, and make the ankle feel weak.

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How does it get injured?

Most Achilles tendon problems are overuse injuries but in a few cases, other medical conditions contribute to weakening or irritating it. These include either high-arched or flat feet since often the heel is out of alignment and this increase the stress on the tendon.

As we get older, the tendon becomes less flexible and less able to absorb the repeated stresses. In some people, this combination of overdoing activity on a less flexible tendon leads to small "degenerative" tears in the tendon fibres. The body will often try to repair these tears and sometimes this process is successful. Often however this process fails due to continued stress upon the tendon, setting up a continual cycle of pain, swelling and weakness. This is called tendinopathy but you may hear it called Achilles tendinitis or tendinosis in other information sources.

Sudden activation of the calf muscle such as during sprinting or playing racquet sports may put so much stress on the tendon that it tears completely, causing an Achilles tendon rupture.

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How would I know if I had an Achilles tendon problem?

Tendinopathy develops gradually. The Achilles tendon and the heel become painful and a swelling may develop in or around the tendon. Initially, the problem may only be during activity, but as the condition worsens, symptoms will present during minimal activity and even when resting.

If you had a complete rupture, you would probably feel a sudden pain in your heel or calf. Some people say this feels as though they had been kicked in the back of the leg. Usually the heel area becomes painful, swollen and bruised, and it becomes difficult to walk.

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Can I treat it myself?

Achilles tendinopathy is treated like any other overuse injury in the first instance. You may need to reduce your activity level. Also, when you exercise, warm up for longer and do plenty of calf stretches. A change to a softer running surface and well-padded running shoes may help. A small heel raise in or on your shoe will reduce the stresses on the tendon but remember to also raise the other side to keep yourself balanced.

For more severe episodes, straightforward measures such as applying an ice pack and taking simple pain-killers (such as paracetamol) are often effective. Anti-inflammatory medicines can reduce the swelling in the tendon, but check with your doctor or pharmacist before taking these as they can have side-effects. If these steps do not help, then consult your doctor or physiotherapist for exercises. These are aimed at reducing the inflammation and then to strengthen the tendon.

Rupture of the Achilles tendon generally cannot heal properly without some intervention and does require prompt medical attention. You should attend your local emergency department or minor injuries unit for assessment and possible plaster cast application.

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When do I need treatment in hospital?

For tendinopathy, the first thing is to check that you have tried all the simple measures outlined above, including physiotherapy. If you have an abnormal foot shape then you may need a referral for insoles.

Your GP may refer you to a hospital specialist if your symptoms continue despite simple measures. Your hospital may then offer you other treatments which may not be available in the community, including surgery.

A ruptured tendon is invariably managed in a hospital setting initially, and once the tendon has started to heal, physiotherapy may be needed to help strengthen the calf muscle and facilitate normal activities. Some patients may be offered surgery depending upon their age, activity levels and pattern of injury. You should discuss this with your orthopaedic surgeon to help decide what is best for you.

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