The Achilles Tendon, Tendinitis, and Tears

Does the back of your leg hurt near your foot? This pain might be the result of Achilles tendinitis. If this is your first experience with foot, ankle, or leg pain, take a look at what you need to know about the Achilles tendon, injuries, and your treatment options.

What Is the Achilles Tendon?

The Achilles tendon is a band of tissue on the back of the lower leg. It connects the calf muscle to the heel bone — and is the largest tendon in the body. Without an Achilles tendon, you couldn’t walk, run, or jump with ease.

What Is Achilles Tendinitis?

Like the name implies, this is a condition that affects the Achilles tendon. If this tendon swells or is irritated, you may experience pain. This combination of back-of-the-leg symptoms is known as Achilles tendinitis. Two primary types of Achilles tendinitis exist: insertional and noninsertional. 

The insertional type of tendinitis affects the lower part of the heel. This is where the Achilles tendon inserts into the heel bone. Insertional tendinitis more commonly impacts long-distance runners, sprinters, or people who overuse the tendon persistently for long periods (such as with years of training).

Noninsertional tendinitis affects the middle area of the Achilles tendon. Tendon fibers in this area start to break down and tear or swell. Very active people are more likely to experience this type of issue.

Is Tendinitis the Only Achilles Issue?

Even though tendinitis, or swelling and irritation of the tendon, is a common complaint, it isn’t the only possible Achilles-related problem. You might also rupture the tendon. This can result in a tear or separation of the tendon’s fibers.

Why Do Some People Have Achilles Issues?

There’s no universal cause for Achilles-related foot, heel, and leg problems. Again, activity can increase the likelihood of tendinitis. While overuse can cause insertional tendinitis over time, some people who are minimally active may also have this issue.

In comparison, noninsertional tendinitis is more likely to happen with higher levels of activity or in younger patients. Sports and other similar high-energy activities may cause a full tendon rupture.

Other risk factors for tendon issues include age (the tendon weakens with age), sex (men are more likely to have these injuries), flat arches of the feet, tight calf muscles, obesity, the practice of running on hilly terrain, the practice of training in cold weather, heel bone spurs, worn or unsupportive shoes for sports or activities, and some types of antibiotic use such as fluoroquinolones.

What Is the Treatment for an Achilles Issue?

Nonsurgical treatment is often the first line of defense against these injuries. Treatment options include rest, ice, non-steroidal anti-inflammatory medications (NSAIDs), physical therapy, calf-stretching exercises, orthotics, supportive shoe choices, and cortisone injections. 

If nonsurgical treatments don’t work or you still have pain after six months, you may need surgery, according to the American Academy of Orthopaedic Surgeons (AAOS). Surgical treatment options include gastrocnemius recession, debridement and repair, or debridement with tendon transfer.

Transfer surgery is necessary when more than 50 percent of the Achilles tendon has damage and needs removing, according to the AAOS. When less than half of the tendon requires removal, professionals can repair and suture the remaining piece.

Can You Prevent Achilles Tendon Injuries and Issues?

You can reduce the risks of an Achilles-related issue. The best methods of prevention include daily stretches, calf-strengthening exercises, the correct shoe choice, cross-training, and the gradual increase of your activity level if you’re new to exercising.

Do you have a calf or lower leg and foot pain or a sports-related injury? Contact the Arizona Institute of Motion for more information on the Achilles tendon.