Achilles Injuries

Q & A

What is the Achilles Tendon?

The Achilles tendon is a strong fibrous cord present behind the ankle that connects the calf muscles to the heel bone (calcaneus). It is used when you walk, run and jump. It is the strongest and largest tendon in the human body.

Common disorders of the achilles tendon include:

Achilles Tendinitis/Tendinosis
Achilles Tendon Rupture

Causes

Most Achilles tendon injuries are “overuse” injuries that result from repetitive activity that cause stress on the Achilles tendon, leading to micro-injury of the tendon fibers. Due to this repetitive stress on the tendon, the body is unable to repair the injured tissue. The structure of the tendon is then altered, resulting in continued pain.

Athletes are at high risk for developing disorders of the Achilles tendon as well as those who are less conditioned and participate in athletics infrequently and sporadically. Achilles Tendinitis and Tendinosis are also common in individuals whose work puts undue stress on their ankles and feet.

What is Achilles Tendinitis/Tendinosis?

Achilles tendinitis is the most common injury to affect the Achilles tendon. This condition happens when the Achilles tendon becomes acutely inflamed and causes pain. This inflammation is typically short-lived. If not resolved, the condition may progress to a degeneration of the tendon (Achilles Tendinosis), in which the tendon loses its organized structure and is likely to develop microscopic tears. Sometimes the degeneration involves the site where the Achilles tendon attaches to the heel bone. In rare cases, chronic degeneration with or without pain may result in rupture of the tendon. Dr. Tien is the lower extremity expert in Orange County in diagnosing and treating Achilles tendinitis in individuals of all ages.

What are the symptoms of Achilles Tendinitis?

You may feel pain, aching, tenderness, or soreness anywhere along the tendon’s path, beginning with the tendon’s attachment directly above the heel upward to the region just below the calf muscle. This is known as insertional achilles tendonitis, when the pain is directly at the insertion of the achilles tendon into the heel bone, or mid-substance achilles tendonitis when the pain occurs somewhere along the course of the tendon prior to its insertion in the heel bone. The pain of Achilles Tendonitis usually starts as a mild ache and worsens over time. When the disorder progresses to tendon degeneration, the tendon may become thickened, enlarged and you may feel discrete lumps or nodules in the tendon itself.

How is Achilles Tendinitis diagnosed?

The diagnosis of Achilles Tendonitis is often a clinical diagnosis made by reviewing your medical history and symptoms and performing a thorough physical exam. Dr. Tien will examine the patient’s foot and ankle and evaluate the range of motion and integrity of the tendon. She may order an ultrasound or MRI to rule out a tendon tear or for surgical planning if surgical intervention is deemed necessary.

How is Achilles Tendinitis/Tendinosis treated?

After diagnosing your condition, Dr. Tien will develop an individualized treatment plan. Achilles Tendinitis usually resolves with non-surgical treatments including:

Activity modification
Stretching exercises
Changing footwear
Wearing heel lifts in your shoes
Physical therapy
Icing the achilles tendon
Taking nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
Immobilization in a cast or boot

When is Surgery Needed?

If non-surgical approaches fail to restore the tendon to its normal condition, surgery may be necessary. As a premier foot and ankle surgeon in Orange County, Dr. Tien will select the best procedure to repair the tendon, based upon the extent of the injury, the patient’s age and activity level, and other factors. This may include open debridement of the tendon or minimally invasive microdebridement of the tendon using radiofrequency technology.

Following surgery, the foot and ankle are initially immobilized in a cast or boot. Your surgeon will determine when the patient can safely begin weightbearing.

Prevention