The Achilles tendon is the strongest tendon in the human body. It enables us to walk, run, climb stairs and really do all of the things that we need to do every day. Very commonly, we neglect to address our Achilles tendon until something starts to hurt. Stretching and proper warm-up for all athletic activities is critical in prevent pain and, ultimately, rupture. If you are guilty of doing half-hearted to no stretching of your heel, it is even more important to address Achilles tendon pain as soon as it starts!
This particular tendon has a region about 4-6cm from where it attaches to the heel bone, where blood flow is decreased. This area is termed the 'watershed' region and is where most tears and ruptures occur. This area of the tendon can become thickened to the point that a nodule can be felt when running your finger along the achilles tendon. In these cases, it is most likely that microtears have occured and the tendon develops this 'nodule' from the scar tissue that forms. Because scar tissue is not as resilient as natural tendon tissue, any level of damage/injury to this area will predispose a person to future tears or the possibility of a rupture. So you see, it can become quite a vicious cycle!
Stretching and proper warm up are the most general recommendations to prevent injury to your Achilles tendon. However, certain antibiotics and other medications can weaken the tendon and increase the risk for tear or rupture also. Injection of steroids is used frequently in the orthopedic world, but be cautious if this is recommended for your achilles tendon pain. Steroid injection into tendons can be damaging enough to cause a tendon rupture while only walking.
Below are possible conditions related to the Achilles tendon, complete with signs and symptoms. If you experience any of these symptoms, don't put off being evaluated by your local podiatrist. If you are or have already experienced pain in your Achilles tendon, don't 'wait for it to go away' on its own. Be proactive and contact our office today for an appointment!
* Acute Achilles tendinitis: This presents as pain and stiffness in the heel cord (AKA achilles tendon). This pain can be worse first thing in the morning and also toward the end of activity. This pain is typically much improved with anti-inflammatories, icing and proper and diligent stretching and warm-up. This is typically the first condition experienced by those prone to Achilles tears and injuries. In some cases there are minute tears within the fibers of the tendon (called interstitial tears) which try to heal over night or at rest, but are quickly re-injured upon activity.
* Chronic Achilles tendinitis: Remember that pain that you noticed in your heel cord about 6 weeks ago (or more!)? If that pain is still present at 6 week or beyond, it means that it is now a chronic condition. Chronic conditions in the body are chemically different, as different cells are recruited to the area of pain. If this goes on long enough, the process damages the tendon tissue further and develops excessive scar tissue and adhesions. Chronic achilles tendinitis can still be treated, but sometimes requires more advanced technology, such as EPAT. Chronic tendinitis may also have small tears which have been or are trying to heal.
* Interstitial tear of the achilles tendon: These tears occur in the same line of the tendon fibers and are sometimes referred to as button hole tears. These can happen from one particular injury but also can develop and worsen over time. These tears, due to their orientation, have a good potential to heal with complete rest from activity for at least 2 weeks, followed by intensive physical therapy. The physical therapy is not only geared towards repairing what was injured, but also at increasing flexibility to decrease further injury.
* Rupture: A rupture is a tear of the tendon across the fibers, like cutting a piece of rope with a pair of scissors. These injuries are the most debilitating, as the achilles tendon cannot function when cut. There are other tendons around the ankle which help you point your toes and walk, but weakness is a huge indicator of a rupture. In addition, at the time of injury many people describe a feeling of their heel sinking into the ground after landing or stepping which follows one large sharp snapping pain in the back of the heel. Suprisingly, some people do not experience lingering pain from a rupture. This is because if the rupture is complete there is no further pull on the tendon. Ruptures are treated by either casting for an average of 8 weeks or with surgical repair of the tendon. Either treatment requires intensive physical therapy following a period of rest while the tendon fibers reconnect.
As you can believe, the best injury to an achilles tendon is NO INJURY at all! Be good to your body and warm up and stretch before strenuous activity!