An Achilles tendon injury onset can be both acute and gradual. The tendon can be torn by stopping and starting suddenly from sports such as tennis, basketball, volleyball, soccer, or football. Achilles tendinopathy or tendinosis may result from overuse or repetitive micro injuries. Rupture of the tendon is more common in the 30-35-year-old age group. The pain from injury is located posterior to the ankle and just above the calcaneous or heel bone.
Achilles Tendon Rupture
The tendon is susceptible by either direct trauma or from sudden force such as pushing the foot away from the floor. Rupture can occur by putting this sudden stress on the tendon with the weight on the front or ball of the foot. Partial tears or ruptures can occur on the outside of the tendon in well conditioned athletes.
The use of steroids and fluoroquinolones (Cipro) has been implicated in weakening and rupture of the tendon.
- Clinical Signs of Rupture – A Sharp “pop” may be heard and felt at the moment of rupture. Some have described it as if they were kicked in the tendon. Weight-bearing becomes almost impossible. A defect may be felt or a lump in the tendon may be present. A MRI may be needed to conclusively diagnose a partial tear.
- Treatment for Ruptured Achilles Tendon – The first option is to use casting or splinting with the foot in flexion. This could be over several weeks and include several castings to move the foot back to a neutral position. Initially, the patient should be non-weight-bearing, use ice, and elevate the foot to reduce swelling. This treatment is best for a partial tear or for someone who is a poor surgical candidate. The second option is surgical repair. Competitive athletes generally are best served to have the tear surgically repaired. There is a lower “re-injury” or re-rupture of the tendon. Both methods will require casting, crutches, ice and elevation.
The age, lifestyle and work requirements of the injured patient need to be taken in to consideration in determining how to treat a complete or partial tear. Treatment options must be discussed with your treating doctor.
Achilles Tendinopathy (Tendinosis)
This condition had been called Achilles tendinitis in the past. The correct terminology is Achilles tendinopathy not tendinitis. However, there is rarely inflammation present other than at the onset of symptoms. Some authorities believe there are subtle inflammatory changes occurring during the degenerative process of the tendon. The tendinopathy usually begins as the result of continuous micro trauma to the tendon. This can include anything from poorly fitting shoes, flat feet, work stress, or sporting activity.
- Clinical Signs – The condition may begin asymptomatic. A small nodule may be noted near where the tendon connects to the heel bone. Pain is noted on moving the foot up and down. Pushing off the back foot when walking can trigger the pain. Inflammation initially may occur in the tissue surrounding the tendon. A classic sign is stiffness in the tendon first thing in the morning and then feeling somewhat better as the tendon warms up. Mild swelling may be present around the tendon. Complaints of lower leg sluggishness and decreased strength are common.
- Treatment – Conservative management is best at this stage. During the initial stage the use of ultrasound ,ice application for the first 48-72 hours, and possible immobilization for 10-14 days in the use of crutches is recommended.
The use of bilateral heel lifts to reduce the strain on the tendon for 30 days rather than using a splint or brace is another conservative approach with mild cases.
Patient comfort is important when deciding on gell or rubber heel lifts. You can choose from soft or a more firm lift. Comfort and fit are both important for the duration of treatment.
~ Dr. Ryan J. Brandt
Once the acute phase has subsided gradual stretching exercises for the tendon are recommended.
Consideration should be given for orthotic supports for correction of foot mechanics such as flat feet. Conservative management could last up to 4-6 months depending upon the extent of the condition. Should this fail to resolve the problem, a surgical consult is warranted.
There may be conditions present in the lower extremity that need to be considered in the differential diagnosis of Achilles tendinopathy. These include the following:
- Retrocalcaneal Bursitis – This bursa is located posterior to the attachment of the Achilles tendon to the calcaneous or heel bone. There is an additional small Achilles bursa that can become symptomatic. This is located between the skin and just above the Achilles attachment to the heel bone.
- Sever’s Disease – This is a condition found in younger adolescent males. It is thought the condition is brought on by repetitive trauma or injury to a growth center by the pull of the Achilles tendon. It more than likely gets worse with activity.
- Stress Fracture – Stress fracture of the heel bone can be caused by excessive hiking, marching or running.
The doctors at Coon Rapids Chiropractic Office have experience in the care and treatment of Achilles tendinopathy.