The Achilles tendon runs from the middle of the calf down to the calcaneus, or heel bone.  It is the thickest and strongest tendon in the body. It has an important role in standing, walking, and running. It is also subjected to a lot of stress; it can be loaded up to 7.7 times the body weight during running. It is not surprising that achilles injuries are one of the most common leg injuries.

Flat feet are often associated with Achilles injuries.  In this case, orthotics are often needed to provide support for the plantar fascia and the Achilles tendon to reduce the chance of injury. Also, women who often wear high heels are putting significant stresses on their Achilles tendons and are at risk for injury.


Achilles Tendon

Achilles Tendon Anatomy

Achilles injuries happen most often when an athlete’s training rate increases rapidly. This tendon is subjected to the most force during quick running starts, which is typically when these injuries occur.  One of the best methods to prevent Achilles injuries is stretching of the calf muscle. These will increase its strength and flexibility.  Follow this link to view some exercises for the calf muscles and the plantar fascia.

There are three common injuries to the achilles tendon, and they are all treated uniquely. These are Achilles Tendinosis, Achilles Tendonitis, and Achilles Tendon ruptures. Tendinosis and Tendonitis are sometimes referred to as Achilles Tendinopathy, but the two conditions are not the same injury.

Achilles Tendinosis is pretty common, but is often misdiagnosed and treated improperly. It is much more common than tendonitis; both are normally overuse type of injuries.  The tendon will be sore and tender to the touch. There will not be any inflammation, but the tendon will often thicken. The fibers of the tendon actually become damaged with micro-tears, and are disorganized and scarred. The damaged area is usually, but not always, in the mid-portion of the Achilles tendon. This injury results in weakening of the tendon to varying degrees, and the risk of rupture to the tendon is significantly increased.

Tendinosis is usually investigated by an MRI and/or ultrasound techniques. Anti-inflammatory medication is not normally prescribed, as inflammation is usually not associated with this injury. Rest for one to three weeks is usually recommended, and training post-injury should be ramped up slowly at first. A customized stretching program and physical therapy are usually encouraged. In more severe cases, a boot or brace may be worn to stabilize the tendon and give the micro-tears a better chance to heal. Surgery is rarely needed unless traditional methods show little progress for at least 6 months.

Achilles Tendinitis is essentially inflammation of the Achilles tendon. The pain and soreness can be similar to tendinosis, which frequently leads to improper diagnosis. Rest is usually required for several weeks. Icing is encouraged, especially in the early stages of the injury. The use of anti-inflammatories (NSAID’s) is usually a part of the treatment.  Corticosteroid injections are sometimes prescribed as well. Calf stretches and heel lifts are usually part of therapy to combat the inflammation and strengthen the tendons. There is no structural damage to the tendons, only inflammation. Surgery is normally not required.

Achilles Tendon Ruptures occur when there is a complete or partial break in the Achilles tendon. The injury can vary from mild to severe, and the treatment methods vary accordingly. Minor injuries usually heal of their own accord, although rest is required. Icing for 20 to 30 minutes several times per day is helpful. 

More severe achilles ruptures require immobilization and sometimes surgery. Many typical achilles ruptures can be treated either surgically or non-surgically.  A boot, or brace, can be fitted to immobilize the tendon and give it a chance to heal. Orthotics can be used successfully in milder cases to provide re-alignment and relief for the tendon. However, the nature and severity of the rupture may dictate that surgery is needed to repair the injury. It can take over a year to recover from a severe Achilles rupture.



— Image courtesy flickr/doctorwonder