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Achilles Tendon Problems

Achilles tendon problems are common, especially in patients who are active. The Achilles tendon is the tendon in the back of the lower leg, connecting to the heel bone, to assist in walking and activity. Problems can arise due to a single event or due to progressive overload. An isolated injury may cause a rupture, partial rupture, or fracture of the heel bone. Progressive overload may lead to inflammation in the tendon, thickening of the tendon, degeneration of the tendon, partial ruptures, or calcification in the tendon.

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An acute injury typically occurs while playing a sport and pushing off of the foot. This may cause a complete rupture of the tendon. The pain may be described as “getting hit in the back of the leg with a baseball bat.” A “pop” may be heard or felt. Prompt treatment of Achilles tendon ruptures is necessary to improve functional outcome. Treatment may be conservative with casting and immobilization or surgical (repair of the tendon).

Progressive overload of the tendon may cause pain in different areas of the tendon. The pain is often 3-6 centimeters up the leg from the insertion of the tendon into the heel bone. Typically this starts as tendinitis (inflammation of the tendon), and the pain is describes as aching or sore, occurring with walking and progressively getting worse. This may eventually lead to a partial rupture or thickening of the tendon (tendinosis or tendinopathy). Another area where the pain may occur is at the insertion of the tendon at the back of the heel bone. This is often described as insertional tendinitis. If the stress in this area continues, one may develop calcifications in the tendon (bone formation in the tendon). This may cause pain, swelling, and a bony prominence in the back of the heel.

Your local podiatrist will be able to evaluate the problem and use methods such as x-rays, MRI, or ultrasound to further assess the condition. Depending on the problem, treatment can be recommended and performed. Conservative treatment methods may include shoegear modifications, stretching exercises, activity modifications, physical therapy, laser therapy, and anti-inflammatory measures. If these methods fail to relieve the pain, surgical treatment may be recommended. The surgery depends on the condition.