Anatomy
The Achilles tendon is one of the largest and strongest tendons in the body. It connects the two calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus). It is required to hold up our entire body weight, provide explosive power and absorb large amounts of shock during jumping, running and other dynamic sport activities. It is no wonder that it can become strained or even rupture.

The calf muscles provide the force that allows us to rise up on our toes. This occurs during walking, running and jumping. The calf muscles also slow us down as our body passes over our feet and as we lower ourselves down. Another job of the calf muscles is to help raise the arch of our foot up (supination) and control the amount of arch flattening (pronation) which occurs naturally with every step we take. All these forces are channeled through the Achilles tendon.

Achilles Tendinosis
When the force is very large or repeated excessively, it can lead to break down of some fibres in the tendon. This leads to pain and thickening of the tendon and weakness and tightness in the calf muscles. Pain can be felt with walking, running, going up/down stairs, jumping, squatting or rising up on the toes. The pain is often severe in the morning when you first walk or when you get up after sitting for a long time. The tendon can be very tender to touch or squeeze anywhere from the lower calf to the heel bone. Because we put force through the Achilles tendon with every step we take it, rarely gets any rest. There is also an area in the tendon with poor circulation. These factors often lead to slow healing and chronic, re-occurring problems.

Treatment of Achilles tendinosis in the acute stage consists of rest, ice, use of crutches (if severe), physiotherapy modalities (ultrasound and electrical current), taping, and gentle range of motion exercises. As the condition begins to settle, the exercises are progressed to include strong calf stretches and strengthening such as calf raises. Having the proper shoes is very import to help support the foot and avoid over-pronation. Occasionally custom orthotic insoles are needed if foot alignment is poor. Other factors such as muscle imbalances or mobility problems in the spine, pelvis, hips, knees or feet can contribute to the problem. A physiotherapist will assess the entire lower body and customize a treatment program for you. They will also guide you back into your activity at a rate that helps prevent re-injury.

Achilles Tendon Rupture
Occasionally the Achilles tendon will partially or completely rupture. This usually occurs after an explosive movement such as jumping in volleyball, lunging for a ball in tennis or squash or sprinting in soccer or baseball. I have also seen it after a slip or fall and even with dancing! People will describe feeling a sharp pop or jolt of pain and they often look behind them to see who or what has struck or shot them in the leg! They then find that they can not walk normally and they can not rise up on their toes. A rupture of the Achilles tendon is a serious medical condition and it requires immediate attention. You should go to the emergency department. They will assess you and probably refer you to an Orthopaedic surgeon. Partial ruptures are usually just immobilized but complete ruptures require surgical correction as soon as possible.

Prevention
Training errors are the most common cause of tendinosis. Usually it is from increasing your intensity (distance, time, frequency, speed) too quickly or not getting enough rest between activity days. Progress into an exercise program slowly and steadily. Avoid excessive hill running until you are ready. Stretching and strengthening your lower extremity muscles can also help prevent overuse problems. Proper footwear is important. Go to a store that sells good quality running shoes and has knowledgeable staff that can pick out the proper shoe for your foot type and activity. If you feel pain beginning in the Achilles tendon, don’t ignore it or try to push through it. Back off your speed, avoid hills, give yourself more rest days, ice after activity and increase your calf stretching. If this doesn’t help, get in to see your physiotherapist sooner rather than later. Once tendinosis is well established it can take many months to rehabilitate it. Don’t let your Achilles tendon bring you down.