The Achilles tendon is the thickest and strongest tendon in the body — so strong that it can support up to eight times the body’s weight when running. It is a fibrous tissue that connects the heel to the powerful calf muscles. Injuries of the Achilles tendon are common in both runners and non-runners. Achilles tendonitis, strains and ruptures can make exercising and even walking difficult and painful.
Achilles tendinopathy, a disorder of the tendon that includes inflammation, tendon disorder and/or small tears in the tendon, usually begins after increasing exercise or not allowing enough rest after exercise. Some people are more likely to get it due to their foot type or the way they walk (such as flat feet that roll in). It can also be caused by improper running technique, tight calf muscles or wearing the wrong shoes.
Achilles tendonitis typically causes pain with the push-off phase of walking or running. Stiffness in the calf muscle is common and thickening of the tendon may occur. When diagnosing Achilles tendonitis, your physician will want to make sure that the tendon has not torn. A complete tear is called a rupture. This is usually signified by a sudden pain and pop in the tendon after starting to run or after falling. A rupture causes significant weakness and difficulty walking. X-rays are usually not helpful in determining rupture. MRI may be necessary if the cause of pain is unclear.
Early treatment of Achilles tendonitis involves rest, using ice and taking anti-inflammatory medications such as ibuprofen. Changing shoes and using heel lifts may reduce pain. Stretching can be helpful during the recovery. If these remedies do not work, physical therapy is often recommended. While Achilles tendon ruptures often require surgery, most patients with Achilles tendonitis will improve with time and exercises. For example, studies have shown that strengthening the calf muscle by slowly dropping the heel as opposed to traditional heel raises can increase strength and decrease pain. In addition, formal physical therapy can help get people back to running and exercising more quickly.
What can you do to prevent Achilles tendon injuries?
Here are a few tips:
• Stretch your calf muscles, especially after exercise
• Always warm up at the beginning of exercise
• Slowly increase exercise duration and intensity
• Wear good fitting shoes that support the heel
Dr. Michael Shea is a primary care sports medicine physician at Blue Ridge Bone and Joint in Asheville, NC. He sees both runners and non-runners at the Same Day Orthopedic Clinic Monday through Friday. He is a member of the Western Carolina Medical Society.