What are Achilles tendon problems?
The Achilles tendon, located at the back of the ankle and linking the calf muscle to the heel bone, is the body’s largest tendon and facilitates activities like walking, running and jumping.
What causes Achilles tendon pain?
Often, especially for active people in middle-age, if there is no obvious cause, tendon pain can be linked to arthritis or other inflammatory issues. Achilles ruptures are normally the result of over-training when the tendon cannot withstand the level of activity.
Tendinitis, an inflammation of the tendon causing pain and swelling, can be triggered by a variety of factors, including a change or intensification of training schedule. There are two forms of Achilles tendinitis:
- Non-insertional Achilles tendinitis occurs when fibres in the central part of the tendon break down due to miniscule tears (or degeneration), resulting in inflammation.
- Insertional Achilles tendinitis affects the lower end of the tendon, close to the heel, where it attaches to the heel bone. Sometimes, bone spurs will form on the heel bone and the sac of lubricating fluid situated behind the tendon (bursa) can get inflamed (bursitis). Insertional tendinitis can affect anyone, whether they are physically active or not.
Achilles tendon pain
- Tendon thickening
- Stiffness and pain, particularly in the morning
- Swelling and pain at the back of the leg near the heel, which is exacerbated by exercise
- Bone spurs (in insertional Achilles tendinitis)
- Swelling worsening with activity
Seek advice as soon as possible as your symptoms may get worse.
Your consultant will listen and discuss the symptoms before performing a range of diagnostic tests, possibly including an X-ray or an MRI scan to determine how much damage there is to the tendon.
Patients with Achilles pain do not always require tendon repair surgery. Frequently, a combination of rest and anti-inflammatory painkillers (under the direction of your GP or consultant), together with a personalised rehabilitation programme of physiotherapy will relieve the pain.
Your consultant may advise a course of steroid injections to control the inflammation. For conditions like insertional Achilles tendinitis, it can be beneficial to wear heel lifts to remove strain from the tendon. Specially designed supportive walking boots can also be useful.
Should the tendon pain not respond to treatment, your consultant may advise that an operation to remove any bone spurs (bony lumps) is necessary. If the tendon is in a very poor condition, tendon transfer surgery, involving the relocation of another tendon in the foot to support the damaged Achilles tendon, is another option.
Achilles tendon rupture
Achilles ruptures or tears affect approximately one in 8,000 participants in competitive sport and occur more frequently in people aged between 30 and 50. An Achilles tendon rupture means no connection exists between the heel bone and the muscles in the back of the calf.
Normally, Achilles tendon ruptures are triggered by over-intensive training putting too much strain on the tendon or the result of sudden stress, such as during a fall when the foot is forced upwards.
People who have suffered with Achilles tendinopathy and older people are most likely to be affected. Further risk factors to consider are:
- Having taken steroids over a long period
- Having undergone steroid injections near the tendon
- Certain antibiotics, if taken over a long period, can weaken the Achilles tendon
- A condition like rheumatoid arthritis, gout or lupus
- Usually, sufferers experience a sharp pain in the back of the ankle, sometimes with a snapping sound
- It is often described as like being kicked in the back of the leg
- Walking is problematic because it is hard to push off using the leg in which the tendon is ruptured
- The tendon swells and becomes bruised, and it may be possible to feel a gap where the tendon has been torn
- However, it can be the case that the rupture does not cause significant pain
Getting medical advice quickly can make treating the rupture easier in the short term and lead to a better long-term result. On the other hand, if the right treatment is not given at an early stage, the tendon can heal incorrectly, resulting in permanent weakness in the calf and restricting running or even walking freely.
Your consultant will discuss how the rupture occurred, and any symptoms experienced. He will then examine the patient and arrange an MRI or an ultrasound scan if required.