Understanding Achilles tendon injuries and tendinosis: What you need to know

The Achilles tendon is the largest and strongest tendon in your body, connecting your calf muscles and your heel. This vital structure is surprisingly vulnerable to injury, particularly among active individuals and athletes. As an orthopedic surgeon with LewisGale Physicians, Patrick Kennedy, MD, with frequently treats patients with Achilles tendon problems, ranging from acute injuries to chronic conditions like tendinosis.

Understanding these conditions and knowing when to seek treatment can make the difference between a quick recovery or long-term complications that affect your mobility and quality of life.

What are Achilles tendon injuries?

Achilles tendon injuries encompass several different conditions. The most common include acute Achilles tendon ruptures, where the tendon partially or completely tears, and Achilles tendinosis, a chronic condition characterized by degeneration of the tendon tissue.

While these terms are sometimes used interchangeably with "tendinitis," tendinosis is actually quite different. Tendinitis involves inflammation of the tendon, whereas tendinosis refers to chronic degeneration. This distinction is important because it affects the treatment.

Common causes and risk factors

Several factors can contribute to Achilles tendon problems. Age can play a significant role, as the tendon naturally becomes less flexible and more prone to injury as we age. Increases in physical activity, like starting an exercise program or dramatically increasing training intensity, can overwhelm the tendon's capacity to adapt.

Certain sports activities carry higher risks, including running, basketball, tennis, and other activities that involve jumping or quick direction changes. Training techniques, warm-up routines, and inappropriate footwear can all contribute to tendon stress.

Medical conditions can also increase your risk. Diabetes, high blood pressure, even certain medications, have been associated with increased tendon injury risk. Additionally, having flat feet or high arches can add to the stress placed on the tendon.

Recognizing the symptoms

With an acute rupture, patients often describe hearing or feeling a "pop" followed by immediate, severe pain in the back of the ankle. You may find it difficult or impossible to push off with your foot or stand on your toes.

Chronic tendinosis typically develops more gradually, with symptoms like stiffness and mild pain. As the condition progresses, you may notice pain during activity, or even swelling around the tendon.

Many patients with tendinosis describe their symptoms as being worse at the beginning of activity, improving somewhat as they warm up, but then returning after they finish exercising. This pattern is quite characteristic of the condition.

Treatment approaches

Treatment for Achilles tendon problems varies greatly depending on the specific diagnosis, severity of the condition, and individual patient factors. For acute ruptures, factors such as the patient's age, activity level, and the location and extent of the tear affect treatment.

Non-surgical treatment for ruptures typically involves immobilization in a cast or boot, followed by rehabilitation. Surgical repair involves reconnecting the torn tendon ends and is often recommended for younger or more active patients.

For tendinosis, treatment is usually conservative at first, with rest and activity modification as first steps.

Physical therapy and strengthening exercises have shown effectiveness in promoting tendon healing.

Other conservative treatments may include orthotics, anti-inflammatory medications for symptom relief.

When conservative treatment fails to provide adequate relief, surgical options may be considered. These can range from minimally invasive procedures to remove degenerative tissue to more extensive reconstructions.

The recovery process

Recovery from Achilles tendon injuries requires patience and commitment to the rehabilitation process. For ruptures, whether treated surgically or non-surgically, the initial healing phase typically involves several weeks of immobilization followed by a gradual return to weight-bearing and movement.

The total recovery timeline for ruptures often ranges from four to six months, with return to some sports activities taking even longer. Physical therapy is essential for regaining strength, flexibility, and proper movement patterns.

Because tendinosis develops over time, healing also takes time, and the long recovery can be frustrating for patients. Gradual improvement over several months with consistent conservative treatment is the expectation.

Key elements of successful recovery include following a rehabilitation program consistently, gradually returning to activities, and maintaining open communication with your healthcare team about your progress and any concerns.

Prevention strategies

While not all Achilles tendon injuries can be prevented, several strategies can significantly reduce your risk:

• Gradually increasing activity levels rather than making sudden jumps in intensity or duration allows your tendons time to adapt to new demands.
• Proper warm-up and cool-down routines are essential, particularly activities that gently stretch the calf muscles and Achilles tendon. Maintaining good flexibility through regular stretching can help keep the tendon healthy and resilient.
• Choosing appropriate footwear for your activities and replacing worn shoes regularly helps ensure proper support and cushioning. Cross-training with different activities can prevent overuse while maintaining fitness.

When to seek medical attention

Certain symptoms warrant immediate medical evaluation. If you experience sudden, severe pain in your Achilles tendon, especially if accompanied by a popping sensation, seek prompt medical care. For more gradual symptoms, it's advisable to consult with a healthcare provider if you experience persistent pain, stiffness, or swelling in the Achilles tendon area that doesn't improve with rest and basic self-care measures within a few days.

Early evaluation and treatment often lead to better outcomes and can prevent minor problems from becoming major ones. As an orthopedic surgeon, I always encourage patients to address concerns early rather than waiting for symptoms to worsen.

Moving forward

Achilles tendon injuries and tendinosis can be challenging conditions, but with proper diagnosis, appropriate treatment, and patient commitment to the recovery process, most people can return to their desired level of activity. The key is understanding that healing takes time and that following your treatment plan consistently gives you the best chance for a successful outcome.

Dr. Patrick Kennedy is a board-certified orthopedic surgeon with LewisGale Physicians, specializing in the treatment of sports injuries and musculoskeletal conditions. For more information or to schedule a consultation, call (540) 772-3530 or book an appointment online.