Achilles tendon: causes of pain and treatment methods

The heel tendon, better known in medical terminology as the Achilles tendon, is the most powerful part of the human musculoskeletal system. It is located between the heel and the calf muscle, which, combining into a single mechanism, transmit the forces of the lower leg muscles to the foot.

Nature has endowed the tendon with incredible endurance, allowing it to withstand weight that exceeds body weight by 5-8 times. It is involved in any manifestation of physical activity - walking, running, jumping, bending and straightening the legs. But, despite its strength, it is easily susceptible to injury and bruises.

What causes Achilles tendon pain?

Pain in the Achilles tendon can be caused by dozens of reasons - natural aging, regular exercise, obesity, bruises and even improperly selected shoes. The most common reasons remain the following:

Age-related dysfunctions. At a young age, the calcaneal tendon can stretch and increase up to 5% of its original size. This allows a person to move without restrictions or discomfort. However, with age, the muscles wear out, losing this ability, which leads to regular injuries and cracks.
Excessive physical activity. Athletes who neglect breaks, warm-ups and warming up their muscles can get injured. The reason for this is excessive stress, which does not allow the tissues to rest and recover in time.
Flat feet. A congenital anatomical defect due to which the ligaments do not function correctly. In addition to pain, a person with flat feet experiences regular swelling and fatigue of the limbs.
Wrong shoes. Long-term wearing of anatomically illiterate shoes leads to joint deformation, and above all this applies to wearing high stiletto heels. When a woman walks in such shoes, the following happens: due to the lift, the Achilles tendon shortens because it does not stretch, as is the case with a flat sole, and begins to be injured. Later, when switching to shoes without heels, a person experiences pain and discomfort.

Less common causes, but which do occur, include hereditary diseases, increased uric acid levels, rheumatic diseases, excess body weight, underdeveloped calf muscles, physical trauma and injury.

Clinical examination

An Achilles tendon rupture can be diagnosed quite easily during an examination by a specialist. The most common location of ruptures is 2.0-5.0 cm above the site of attachment of the tendon to the heel bone. The main way to determine the presence or absence of an Achilles tendon rupture is to perform the Thompson test .

The patient is placed on his stomach so that his feet hang freely over the edge of the couch, after which the doctor squeezes the calf muscles. If the integrity of the tendon is not compromised, the foot will rise [plantarflexion]. If there is a tendon rupture, there will be no movement.

Often patients mistakenly believe that their tendon is working normally if they can move their foot up and down. However, this is only possible in a sitting position because the adjacent muscles and tendons are not damaged.

When you try to lift your leg up in a standing position and transfer your body weight to the injured limb, pain and weakness will appear. If an Achilles tendon rupture occurs, it will be incredibly difficult for the patient to stand on their toes for any length of time - this is called the STAMP test . Sensitivity and blood circulation in the foot and ankle are usually not affected.

Achilles tendonitis

This disease is described as a pathological inflammation of tendon fibers. Most often it affects professional runners, tennis players, basketball and volleyball players who do not control the intensity and smoothness of sports training. The disease is accompanied by classic symptoms - redness, swelling, pain and stiffness of movement. Pain usually occurs during activity and subsides during rest.

During inflammatory processes, the following picture occurs: the removal of salts and metabolic products from the tissues is disrupted, causing the fibers to lose their strength and flexibility. If they continue to receive load, cracks and micro-fractures form. Over time, the tendons recover, but lose elasticity and acquire scars, therefore, in order to prevent chronic consequences, it is necessary to seek help in time.

CAUSES OF TENDINOPATHY

The Achilles tendon is a dense bundle of collagen fibers. With regular exercise, the fibers do not receive sufficient nutrition and begin to break down. The more damaged fibers, the greater the discomfort. If the patient makes no attempt to stop the process, acute tendinopathy becomes chronic. In this condition, even a minor injury is dangerous: the already damaged tendon can rupture.

To prevent the condition from becoming critical, tendonitis must be treated on time, immediately after the first symptoms appear. Treatment will be quick and truly effective if you entrust it to a neurologist or orthopedist at Doctor Ost MC and do not self-medicate.

Inflammatory processes of the Achilles tendon

Inflammation of the Achilles tendon, referred to in medical terminology as “tendinitis,” is a disease characterized by pain and impaired musculoskeletal function. The first people to be susceptible to tendinitis are professional athletes involved in jumping and long-distance running. In addition, the cause of the pathology are:

increased physical activity without prior preparation;
falling from height;
developing achillobursitis;
calcaneal injuries;
wearing tight shoes or high heels;
infection of the tendons;
heel spurs;
rheumatoid arthritis;
gout;
diabetes.

The symptoms of the disease remain classic: a burning pain appears, intensifying with movement, as well as in the morning. May be accompanied by lameness, stiffness, swelling and fever. Achilles tendon rupture often occurs , which, without timely treatment, develops into muscle atrophy. It is worth considering that ruptures cannot be repaired and require surgical intervention.

Prognosis for recovery

Considering Achilles tendinitis and reviews of the treatment of this disease, we can conclude that the recovery period primarily depends on the degree of damage. With a timely visit to a specialist, more than 80% of patients can count on positive treatment results. In this case, the rehabilitation period can reach 3 months.

The resumption of usual physical activity must be carried out gradually, which will prevent deterioration of the heel tendon.

Achilles tendon bursitis

Achilles tendon bursitis is an inflammatory process affecting the tendon bursa. Its development is caused by injuries, tight and uncomfortable shoes, and gout. Depending on which side of the tendon its focus arose, posterior and anterior bursitis are distinguished:

Posterior bursitis. Occurs mainly in women as a result of wearing high heels. The lift provokes so-called “bumps”, which lead to the disease. Early symptoms include pain, redness and hyperthermia, and late symptoms include a hard and tender growth known as Haglund's deformity.
Anterior bursitis. A disease that is also known as Albert's disease. It can be caused by any condition accompanied by a load on the tendon area. Associated diseases are gout and rheumatoid arthritis. If the cause is a bruise or gout, the symptoms develop quickly, but if other disorders develop gradually. Symptoms include pain, swelling and red spots spreading on both sides of the heel.

Recovery and rehabilitation

To quickly restore Achilles tissue in case of chronic or acute illness or injury, it is necessary to strictly follow all the instructions of the attending physician.

Clinical recommendations for the rehabilitation period:

reduce the load on the affected leg as much as possible;
move for some time with the help of a cane or crutches (if necessary);
if intense pain occurs or swelling increases, you should immediately inform your doctor about the appearance of other manifestations of the disease;
maintain bed rest immediately after surgery and during severe pain;
reducing pressure on the tendon by purchasing good special shoes;
fix the ankle joint and foot with an orthosis or wear an elastic bandage for a period of one to three months;
Be sure to use physical therapy in the late stages of recovery.

Symptoms of heel tendon diseases

Regardless of what caused the inflammation, you can always emphasize the same symptoms:

redness in the area of the diseased ligament;
increased sensitivity and pulsation;
discomfort that increases when the patient leans on the foot;
pronounced swelling of soft tissues;
increased body temperature;
sharp and burning pain stretching from the heel to the calf muscle;
A crunching sound may be heard in the joint.

If the cause of pain is a tear of the Achilles tendon , other symptoms are added:

sharp pain similar to a mechanical shock;
the patient is unable to stand on his toes or extend his foot forward;
palpation of the “notch” in the affected area;
the swelling site turns blue.

Medical diagnostics

Diagnosis of the disease is carried out by examination and detailed questioning of the patient. As additional measures, doctors resort to ultrasound and magnetic resonance therapy. Less commonly, radiography is used. X-ray is ineffective in identifying the cause of pain, since tendon tissue does not retain X-ray radiation, but it can detect fractures. After the doctor has made a diagnosis, comprehensive treatment of the Achilles tendon .

How to Diagnose an Achilles Injury

The Achilles tendon is very strong and elastic; it is not easy to damage, but it is possible. If an injury occurs, the regeneration process will take time.

Achilles is a plexus of dense collagen fibers, and during their regeneration, damaged fibers are replaced with new ones, but this process is not quick. Plus, the tendon has poor blood circulation, such is its structure, and this also reduces the rate of self-regeneration.

Sometimes Achilles problems are mistaken for sprained ankles and vice versa. So the specialist will draw conclusions based on examination and history taking, and may prescribe an X-ray or ultrasound examination or magnetic resonance imaging (MRI).

A severe Achilles injury cannot be ignored or tolerated. An Achilles rupture is not just pain, it is the inability to move the foot. So there is no way around this without surgery.

The good news is that mild to moderate injuries will heal on their own with a little help from you, as recommended by your doctor.

Conservative treatment

The essence of conservative treatment is complete immobilization of the lower leg. When fixing the leg, it is necessary to achieve an elongated toe, which will allow the torn fibers to slowly grow together. Foot immobilization lasts on average 6-8 weeks and is carried out using the following methods:

splinting;
application of sports tapes (tapes);
fixation with orthoses, which, depending on the severity of the disease, can be night or around the clock;
gypsum, sometimes polymer;
applying a bandage made of an elastic bandage;
prescribing auxiliary crutches.

As medicinal measures, the doctor prescribes analgesics, anti-inflammatory drugs, and vitamin complexes. Massage and physiotherapy may also be prescribed.

Treatment of Achilles diseases

In acute cases, conventional methods are indicated. Reducing physical activity, using anti-inflammatory drugs for pain, special exercises to stretch the tendon, massage. To limit the range of motion, it is possible to use soft orthoses and elastic bandages.

Healing chronic inflammation or old injury requires more effort and time. It is recommended to immobilize the ankle joint with rigidly fixing orthoses. Kinesio taping is used to unload the tendon using special adhesive tapes, and physiotherapy.

Surgical treatment is used as a last resort when conservative treatment does not bring results within a certain time.

Medicines

To relieve inflammation of the heel tendon and pain syndrome, medications are prescribed by a doctor based on the characteristics of each case:

NSAID drugs work effectively in combination with other drugs. Ketorolac, Nimesil, Baclofen, Meloxicam are usually used.
High fever must be reduced with antipyretic medications.
A compress of Dimexide with Novocaine , Hydrocortisone or Dexamethasone is recommended to be used day or night for several days to reduce swelling.
At home, various ointments and gels based on combined products will help you get rid of pain - you can smear Solcoseryl, Bytrumgel, Dolobene gel, Nurofen gel, Butadione.

Meloxicam

Nimesil

Baclofen

Dimexide

Bystrum

Dolobene gel 50 grams

Fixation

Methods for fixing the ankle should be selected by an orthopedic surgeon:

A good way to protect yourself is to wrap your leg tightly with an elastic bandage before training. Also, if you feel pain, you can also use a bandage that will securely fix your legs and will not allow you to strain this part.
It is possible to apply kinesio tape during training.
You can also wear an orthosis or bandage at night . It is used to fix the foot bone at a right angle. In advanced forms of the disease, it is not recommended to remove it during the day.
Sometimes, when standard treatment is ineffective and the athlete is highly active, the traumatologist is forced to plaster the ankle and leg to the knee in order to avoid the consequences and complications of the injury. In this case, wearing the plaster usually extends for a period of 1.5 to 4 months.

Foot support orthosis Night orthosis

Articulated orthosis for tendon injury

Exercises

When performing exercises, you need to monitor pain sensations; if pain occurs, exercise or stretching should not be performed.

A few simple exercises to do before each workout that will help avoid many problems:

Exercises with dumbbells to stretch muscles. It is effective to lunge with your left or right leg, while the other leg remains bent behind you. The body needs to be lowered quite slowly and low.
You can also do jumps, that is, lunges at higher speeds . The exercise is done 10-15 times daily.
Tiptoe walking exercise. You can perform it either with dumbbells in outstretched arms or without them. You need to walk like this for 3-5 minutes, stretching your whole body and straightening your shoulders. Then you can take a break and do another approach.

Recovery Exercises

Performing classic stretches against a wall, which athletes do before running, will also help prepare the muscles and ligaments for the load.

Physiotherapy

Physiotherapy has a good effect in treatment. The therapy allows you to stretch the muscle, which helps relieve tension on the Achilles. Therapeutic ankle massage, ultrasound and weak current pulses are used.

Operation

In case of a complete rupture of the Achilles or injury to the triceps muscle of the leg, an operation to suturing parts of the tendon is necessary to eliminate the consequences. Moreover, the sooner surgery is performed, the faster tissue restoration can be expected.

Modern surgical technologies make it possible to treat the Achilles tendon with minimal trauma, therefore, the recovery time after surgery is significantly reduced.

Tendon suturing surgery

Operative methods

If conservative treatment does not help, Achilles tendon surgery . It is often resorted to if the patient has severe damage, in particular a rupture. Surgical intervention is performed in two ways - stitching or plastic surgery:

Stitching. It is used if the rupture is fresh, received within the last 24 hours.
Plastic. Usually it is resorted to if long-term conservative treatment has not helped. The operation is quite complex and is aimed at transferring a piece of tendon from one part of the lower leg to another. After the manipulations have been performed, the patient is given a plaster cast.

Which doctor should I contact?

If your Achilles tendon hurts, which doctor should you contact - this is a question many patients ask, since most clinics do not have a specialist who treats diseases of the musculoskeletal system. Let's try to give some practical advice:

if you are in Moscow, then call our manual therapy clinic and make an initial free appointment with an orthopedist - the problem will be solved in one phone call;
if you had an injury to the ankle joint before the onset of pain, then regardless of where you are, urgently go to the nearest emergency room or call an ambulance (if you cannot move independently);
if there was no injury and you are not in Moscow, then visit a city or regional clinic and make an appointment with a therapist or surgeon there.

The leading specialist who deals directly with the treatment of all problems associated with the musculoskeletal system is an orthopedist. If possible, make an appointment with an orthopedist.

Achilles tendon rehabilitation

After surgery, rehabilitation time is on average 1–3 months. Not only the strength of the sutures, but also the likelihood of re-injury depends on compliance with restorative measures. Measures include a state of complete rest, lack of physical activity and fixation of the foot in an elevated position. Traditionally, rehabilitation includes the following stages:

The use of painkillers and anti-inflammatory drugs.
Wearing a plaster cast for the first week after surgery.
After removing the plaster, careful development of the joint begins, but without putting stress on the sore foot. In this case, crutches are used.
After one to two months, bandages and orthoses are applied.

The most important thing in rehabilitation is its gradualness, because any careless premature measures lead to rupture of the stitches.

Complications after surgical treatment

Non-healing of wounds

Although usually a common complication for most surgeries, complications in wound healing are especially problematic in Achilles tendon repairs. Because in the area of the Achilles tendon there is little surrounding soft tissue, and this area of skin has a notoriously poor blood supply.

Therefore, any kind of wound healing problem can easily affect the tendon itself. For most patients, there is approximately a 2-5% risk of developing a wound healing problem. However, this risk increases significantly in smokers and patients with diabetes.

Infection

Deep infection after Achilles tendon repair can be a huge problem. Often an infection occurs if there is a wound healing problem that allows bacteria from the outside world to infect the repaired Achilles tendon.

Treatment may require not only antibiotics, but also the possible removal of all suture materials and, in some cases, removal of the tendon. Smokers and diabetics are at increased risk of serious wound infection after Achilles tendon repair surgery.

Nerve damage/neuritis

Numbness of the skin in the area of the postoperative scar is a fairly common complication. A more serious problem is damage to the nerve that controls muscle function or sensory control. This can happen when a nerve is involved in a suture or damaged by an instrument during surgery.

Damage to one of the nerves in the foot often results in neuritis (painful inflammation of the nerve). The initial injury to the nerve may be relatively minor, such as: a nerve that is stretched when soft tissue is retracted during surgery; or a nerve that becomes entangled in scar tissue that forms in response to post-operative bleeding.

This type of nerve irritation creates symptoms such as numbness and/or a burning sensation along the nerve. Localized nerve damage is often associated with a surgical incision, and pressing on the area of nerve damage can cause sharp pain or discomfort along the path of the nerve.

Preventive measures

To never have troubles with your ankle, you just need to remember about preventive measures. These include exercises for the Achilles tendon , well-chosen shoes, and a balanced diet:

Warm up the ankle before complex physical exercises.
Properly pump the calf muscles, thereby strengthening the limb.
Practice the “jumping” exercise - they will ensure the elasticity of the fibers.
Practice exercises aimed at stretching the tendon.
Eat enough protein, calcium and vitamin D.
Minimize heels and stilettos in everyday life.
Buy anatomically correct shoes, namely with a hard back.

If you experience pain and discomfort in the tendon area, self-medication can play a cruel joke on you - lead to lameness or chronic inflammation. The Center for Rehabilitation Medicine offers you consultation with competent orthopedic traumatologists, advanced treatment methods and individual rehabilitation.

Free, unrestricted movements are part of our full life, so any alarming signal is a reason to call us.

You can find out the prices of the clinic in the price list or by calling: +7 (8552) 78-09-35, +7 (953) 482-66-62.

Active treatment of Achilles injury

The doctor should give an approximate time frame for when improvements can be expected—a reduction in inflammation and pain. Then it is too early to return to running, but you can already begin therapeutic exercises, for example, physical therapy exercises.

Physical therapy or exercise therapy is a set of stretching and mobility exercises that can be started only after inflammation has subsided. It is recommended to perform gymnastics without sudden movements, smoothly, gradually increasing the volume of exercises.
Exercise therapy should be done under the guidance of an instructor, because improper execution will lead to a worsening of the condition.
It is important to warm up the Achilles tendon well before starting exercises; self-massage and kneading are allowed here.