by Stephanie Florence, DPM / Foot & Ankle Specialty Care / UPMC Susquehanna - July 1, 2020

Summer is here, which means it’s a great time to increase our activity levels and truly enjoy all that the warm weather has to offer. Whether you are heading out for a walk, hike, or other activity, it’s important to consider a gradual approach when transitioning from the winter couch potato to the warm-weather “weekend warrior” to avoid injury.

The largest and strongest tendon in the body, the Achilles, anchors the calf muscles to the heel bone — which subjects it to very high forces. Achilles tendon problems are very common, especially among middle-aged weekend warriors who don’t exercise regularly. The human body has a tremendous capacity to adapt to physical stress. While we tend to think of “stress” negatively, physical stress, which is simply exercise and activity, is beneficial for our bones, muscles, tendons, and ligaments, making them stronger and more functional by the repetitive breakdown and buildup of tissue. When you are active and moving, such as when running, the Achilles tendon can pull with a force equal to many times the body weight. The tendon can weaken and degrade over time, especially if you have a sedentary lifestyle, causing pain and inflammation and putting you at risk of injury such as a rupture.

Types of Achilles Tendon Injuries

Achilles tendon injuries may seem to happen suddenly, but they usually result from tiny tears that happen over time. These chronic, or long-term injuries, to the tendon microstructure, such as Achilles tendonitis or Achilles tendinosis, often result from overuse and sudden increase in amount of or intensity of physical activity, as well as from wearing high heeled shoes and in individuals with high arched or flat feet. Symptoms of these types of injuries include lingering pain or swelling and should not be ignored as the symptoms may be an early warning that you’re at risk of a more traumatic injury, such as Achilles tendon rupture.

Achilles tendon rupture happens when tendon fibers tear and separate. Therefore, the tendon can no longer function normally. Risk for rupture increases when you put off treatment for tendonitis or tendinosis and continue activity. Most often the injury occurs during activity, such as a swift change of direction or a jump, which puts additional strain on the weakened tendon causing rupture, often with an audible “pop.” This rupture is often described as feeling like being shot or kicked in the back of the ankle and can make it hard, if not impossible, to stand or bear weight.

Treatment Options

Regardless of the injury, don’t push through the pain. Early treatment is key to staying active while treating Achilles tendon injuries. Consult a physician if you have pain that doesn’t improve with rest. The diagnosis can usually be made after a thorough history and physical examination. This is best done by a foot and ankle specialist with specific interest and knowledge of your activity. In some cases, x-rays are needed and occasionally additional tests like a bone scan or MRI are required as well.

Minor Achilles tendon discomfort can be treated with rest, anti-inflammatory medication, stretching, and moist heat. While some pain and discomfort may be the result of age or being out of shape, you should seek care from a specialist when the discomfort lasts longer than a month, or if your discomfort starts to affect your lifestyle. Minimally invasive procedures and physical therapy can often help in treating minor Achilles tendon injuries such as tendonitis and tendinosis. These minor treatments may require you to slow down or decrease activity for a few weeks, however, they can prevent additional injury which can sideline you for months.

Treatment for severe problems, such as a torn ruptured tendon, may include surgery, or a cast, splint, brace, walking boot or other devices that immobilize the lower leg. Surgery includes removing a bone spur that is hitting the Achilles tendon, repairing the tear, removing the damaged portion, and transferring the tendon to the heel bone to restore motion. Patients who undergo surgery can expect to be on crutches and in a cast for six to eight weeks, followed by months of therapy. It may take up to a year to reach maximum improvement. Although it takes time, the treatment of Achilles tendon problems usually works with most people returning to sports and other activities.

Prevention

Overuse injuries, such as Achilles tendonitis and tendinosis, can be prevented with proper training and heightened awareness while doing physical activities. Whether you’re a seasoned athlete or weekend warrior, you must learn to listen to your body. Always remember to warm up and cool down properly before and after activity. Incorporating strength training, increasing flexibility, and improving core stability will also help minimize risk of injury. Seek the advice of your primary care provider or an athletic trainer when beginning an exercise program or sport and take your time to let your body get used to the increased or new activity.

Stephanie Florence, DPM, is a foot and ankle specialist with UPMC Orthopaedics. She sees patients at UPMC Wellsboro Office of Foot and Ankle Services, 103 West Ave., Wellsboro. For more information or to schedule an appointment, call 570-724-5297.