Protecting Your Achilles Heel

Sports and related activities can cause a number of injuries, including an Achilles tendon rupture. The Achilles tendon is a strong cord in the leg that connects the calf muscles to the heel bone, and if it becomes overstretched, it can tear partially or completely (a full tear is called a rupture).

Pain from an Achilles tendon rupture can be extreme, and a rupture will often require surgery—though newer research may indicate that non-surgical procedures are just as successful for many people.

Symptoms

If you partially or fully tear your Achilles tendon, you may feel a distinct popping or snapping in the back of your leg, followed by immediate pain. You may also have trouble walking. In some cases, it’s possible to not experience any symptoms, but in others, symptoms include:

Swelling near the heel
Inability to stand on the toes
Inability to bend foot downward

Achilles tendon injuries are serious, and if you experience any of these symptoms, see your doctor right away.

Causes and Risk Factors

The Achilles tendon is a strong tendon, and ruptures usually occur in the area where it attaches to the heel itself. These ruptures are often caused by a sudden increase in pressure—during sports (especially those that involve jumping) or a fall from a higher distance. Stepping downward onto a lower surface can also stretch the tendon.

A few factors that can increase your risk of Achilles tendon rupture include:

Gender: Achilles tendon ruptures are up to five times as common in men as they are in women.
Age: People between the ages of 30 and 40 are at the highest risk.
Steroid injections: Steroid injections meant to reduce ankle pain and inflammation can weaken other tendons in the area, including the Achilles tendon.
Sports: Achilles injuries are common in people that play sports like football, soccer, dance, tennis, volleyball, gymnastics or running—these sports all involve increased pressure on the joint, pivoting, and the need to quickly speed up and slow down.
Antibiotics: Certain antibiotics increase the risk of tendon rupture.

Treatment

Treatment for a ruptured Achilles tendon depends on a few factors, including age and severity of the injury. There are both surgical and non-surgical options. Let’s look at both.

Surgery: During an Achilles tendon surgery, your surgeon will make an incision in the lower leg and repair the tendon by stitching it together. If there’s a need, other tendons may be used for more support. Surgery can include complications like infection or nerve damage in some cases, but the likelihood of a second rupture is lower.
Nonsurgical options: Less severe ruptures won’t often require surgery, instead, you may have to wear a cast or walking boot with support for the heel. You may also be asked to give the injury time to heal by resting, raising, compressing and icing the injured leg. Your doctor may recommend anti-inflammatory medication as well. This type of treatment is far less invasive and reduces the risk of infection. However, recovery from nonsurgical treatment may take longer, and a second rupture is more likely—if this does occur, surgical repair might be more difficult than it would have been after the initial rupture.

Both forms of treatment will be followed by rehabilitation. You’ll be given exercises and stretches, and if everything goes well, you can return to activity within four to six months.

Prevention

Much of the prevention for Achilles ruptures involves limiting sudden, intense strains on the tendon, causing it to stretch beyond its limit. Some tips include:

Stretch: Especially in the calves, stretching is vital. Stretching helps prepare the tendon for larger amounts of force and give it more flexibility. Don’t bounce or strain yourself while stretching—stretch only to where you feel a pull, but not pain.
Manage your intensity level: Avoid sudden increases in intensity level. Make these increases moderate to help the tendon adjust slowly.
Change it up: Another way to strengthen the Achilles tendon is to vary your forms of exercise. Mix low-impact exercises like swimming or biking with higher-impact ones like running and jumping.
Be careful on certain surfaces: If possible, try not to run or jump on surfaces that are too hard, or too slippery.

If you experience pain in the back of your lower leg and you’re worried it might be an Achilles rupture, speak to your doctor right away.

Orthopedics is rewarding for me because it allows me to help patients with injuries and get them back into action quickly. I love meeting people of all ages in my practice—I see kids, athletes, adults and retirees. I enjoy being able to understand people’s unique situations and trying to help them recover. I tend to be conservative with my surgical treatment, and much of my training is in minimally-invasive procedures, such as arthroscopy.