Story by: David Steen Martin; Reviewed by Andrew R. Harston, M.D. on December 1, 2023
Probably the most severe Achilles tendon injury is a rupture, or complete tear, of the tendon. An Achilles rupture — a severing of the tendon that connects the calf muscle and your heel bone — often results in sudden pain in the back of your ankle and lower leg, accompanied by a snapping or popping sound.
The injury is most common among men between the ages of 30 and 50 playing recreational sports, such as soccer, tennis or basketball. Achilles tendon ruptures are more frequent in sports that require jumping and sudden stops and starts.
Some who rupture their Achilles say they felt something before the injury. This might be pain above your heel, especially when stretching your ankle or standing on your toes.
As the biggest tendon in the body, the Achilles often is called upon to handle significant loads.
An Achilles rupture can occur as “someone playing pickleball or tennis or driving to the hoop playing basketball, then their weight on it and the load across it as they try to push off with that foot is too much for the tendon to handle,” said Andrew R. Harston, M.D., orthopedic surgeon with Norton Orthopedic Institute.
Risk factors for an Achilles tendon rupture include:
Less severe than to rupturing your Achilles tendon is a strain. When strain on the tendon causes inflammation, you have Achilles tendinitis.
Obesity, tight calf muscles, and feet with a naturally flat arch all put more strain on the Achilles tendon, making Achilles tendinitis more likely. Achilles tendinitis is also more common in men than women and becomes more common as you age.
Psoriasis and high blood pressure also make it more likely.
If you’re a runner, old shoes, cold weather or hilly terrain all increase the chance of developing Achilles tendinitis.
Sports medicine specialists and orthopedists provid e experience and expertise treating injuries that result from athletics or just everyday wear-and-tear.
Achilles tendinopathy has similar symptoms to tendinitis. While tendinitis is an inflammation of the tendon, tendinopathy is a result of the tendon’s collagen protein breaking down. Both are often caused by overuse or a sudden shock to the tendon. Achilles tendinosis describes chronic damage or inflammation. If you have Achilles tendinopathy, it can weaken the tendon, making a rupture more likely.
A ruptured Achilles tendon often requires surgical repair. Surgical treatment will re-approximate and secure the tendon ends so they can heal.
Nonsurgical treatment is appropriate for most non-rupture Achilles injuries or aggravations, according to Dr. Harston.
With Achilles tendinitis, several days of rest usually helps.
You can take an over-the-counter non-steroidal anti-inflammatory drug (NSAID) like ibuprofen (Advil, Motrin) to reduce inflammation. Icing or wrapping your Achilles tendon and elevating it when you’re sitting and lying down also helps.
The RICE method is also often helpful for minor tendon injuries:
For severe tendonitis, immobilization with a CAM boot can be helpful.
After Achilles tendon surgery, you can expect two to three weeks of immobilization, with no weight on the foot.
Typically, your health care provider will replace the post-surgical splint with a special boot two to three after surgery, which you’ll wear for six to eight weeks before transitioning to sneakers.
It usually takes four to six months before you can return to all athletic activities, such as running or jumping.
Aaron Rodgers, in his debut as the quarterback for the New York Jets, suffered a torn Achilles tendon in September 2023. He underwent surgery shortly afterward. The 39-year-old four-time MVP in the National Football League said he had set a goal of returning to action in time for the playoffs, which begin in mid-January 2024.
You can reduce your risk of an Achilles tendon injury by stretching daily, warming up before you exercise and increasing your activity level gradually.
If you are going to put a lot of stress on your Achilles tendons, such as running hills or playing basketball, warm up by exercising at a slower pace. If you notice any Achilles tendon pain, stop and rest.
“Stretching your calf with the knee held straight and feeling that burn all the way up behind your knee is a good regular thing to do before and after, not just activity or exercise, but when you get up in the morning or when you get ready for bed at night,” Dr. Harston said.
Your shoes should provide arch support and adequate cushioning for your heels. If they don’t, try arch supports. A special shoe insert that elevates your heel slightly can reduce the strain on your Achilles tendon when you’re exercising. Replace your worn-out shoes.
Take the time to stretch your calf muscles and Achilles tendon before and after exercise to maintain flexibility. This is especially important to avoid a recurrence of Achilles tendinitis. A physical therapist can prescribe stretching and strengthening exercises.
Strengthening your calf muscles also can reduce the strain on your Achilles tendons. Strong calf muscles enable the calf and Achilles tendon to better handle the stresses of exercise.
Cross- training also lessens the strain on your Achilles tendons. Try alternating sports that involve running and jumping with low-impact activities like swimming and cycling.
The Achilles tendon is the strongest tendon in the body, but you need to take care not to put too much stress on it, especially as you age.
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