The achilles tendon is the strongest and largest tendon in our body. It connects the calf muscle to the heel bone in the back of the foot. The tendon allows us to walk, run, jump and stand on our toes.
When repetitive stress is placed on the tendon, you can develop microscopic tears. As these tears get worse, the tendon tissue weakens which leads to chronic pain or even tendon rupture.
The achilles tendon has an area about 2–6 centimeters above where the tendon attaches to the heel bone which is known as the “watershed region”. There is a relatively limited blood supply in this area of the tendon. This is the area of the tendon which is very vulnerable to injury and the healing potential is poor in this area. Due to degeneration over time and overuse, many ruptures occur in this region.
There are many causes to develop achilles tendon pain. They can range from gradual over strain of the tendon to an acute single injury. The common causes of gradual overstrain of the tendon include running uphill, sprinting, jumping sports, age-related tendon changes, worn out or unsupportive shoe gear, poor foot mechanics such as flat feet, high arches and tight calf muscles.
The common causes of acute injury to the tendon can include a sudden increase in exercise after a long period of inactivity, starting a new exercise program, increasing training mileage too quickly and a sudden explosive jumping motion.
Less common causes of achilles tendon pain may be associated with inflammatory arthritis, autoimmune disorder, certain medications such as fluoroquinolone antibiotics and corticosteroid injections near the tendon.
The common symptoms of achilles tendon injury can include pain in the back of the heel or lower leg with activity, swelling in the back of the heel or lower leg, pain when pushing off the foot or when standing on your toes and stiffness in the morning or after periods of rest.
If you feel or hear a sudden “pop” in the back of your lower leg with immediate weakness, that usually indicates a rupture of the tendon.
There are many treatment options for achilles tendon pain. Most treatment options are non-surgical if the tendon didn’t rupture. The initial steps to deal with achilles tendon pain is to reduce high impact activities such as running and jumping. Wearing supportive shoe gear and using a temporary heel lift will reduce strain off the tendon.
Gentle calf stretching will improve flexibility. Anti-inflammatory medication and ice will reduce the inflammation in the tendon. Physical therapy will help improve flexibility and strengthening of the tendon.
In more severe cases of tendon pain, a walking boot may be used for complete immobilization of the tendon. For chronic cases that do not improve with conservative care, regenerative medicine options such as EPAT (shockwave) and PRP may be considered to stimulate healing.
It’s best to seek medical evaluation if the pain persists and lasts more than 2 weeks, symptoms are worsening, swelling is increasing and/or sudden weakness of the leg. When treated early, recovery is often faster and less complicated.
If achilles tendon pain is ignored, this can lead to worsening of the degeneration of the tendon and risk of rupture.
If you are experiencing persistent pain in the back of your heel or lower leg, seeking prompt evaluation is the first step toward recovery. Most patients are able to return safely to their normal activities with an accurate diagnosis and a personalized treatment plan.
Dr. Joseph Cione is a board certified Podiatrist with offices in Manhasset, Woodbury and Mineola. Dr. Cione is known for his thorough evaluations, precise diagnosis and compassionate approach to patient care. His goal is to relieve pain and address the underlying cause of the condition so patients can return safely back to work, sports and daily activity.
