Achilles tendon - treatment and recovery
You surely remember the Greek hero from the Iliad, Achilles and his heel? Yes, the one whose mother dipped him into the water while holding him by the heel, which made him invulnerable everywhere except in the heel that remained above the water. And of all the places on the body, his opponent struck him with an arrow precisely in the heel. The outcome was fatal, but the Achilles heel, that is, the Achilles tendon, has lived on as a synonym for anyone’s weak spot.
Why is the Achilles tendon so important? Quite simply, without it we would not be able to rotate the foot into various positions. In practical terms, this means we would not be able to walk. And without walking, our lives would be unimaginable and, in practical terms, impossible to live. What is the Achilles tendon? How can we protect it? How is it treated when Achilles tendon inflammation occurs? Is natural treatment possible, and does it give results?
What is the Achilles tendon?
The Achilles tendon is the longest tendon in our body, on average about 15 cm long. It is located on the back of the lower leg and connects the calf muscles to the heel bone. It is highly elastic and durable, as demonstrated by the fact that it can withstand four times the body’s weight. For this reason it is classified as the strongest tendon in our body. As we have already noted, through it the calf muscles rotate the foot around the ankle joint. This is what enables us to put the foot in various positions, from standing, jumping, running, and rising onto the toes, to climbing stairs.
The Achilles tendon has three parts:
- The uppermost part, located at the level of the calf muscles, the so-called non-insertional Achilles tendon
- The middle tendon, located at the narrowest part of the ankle and the bottom of the calf, the pre-insertional Achilles tendon
- The point of attachment between the heel bone and the tendon, the so-called insertional Achilles tendon
When pain appears in the Achilles tendon along with certain symptoms, it usually indicates that a rupture or inflammation of the Achilles tendon has occurred.
Achilles tendon pain - symptoms and complaints
Inflammation and rupture of the Achilles tendon are accompanied by the following symptoms:
- Pain that intensifies over time
- Pain that appears especially when walking uphill
- Swelling
- Bruising
- Elevated temperature
- Redness
- Difficulty moving
- Inability to rise onto the toes in more severe injuries
- A palpable thickening may appear
When does Achilles tendon inflammation occur?
Inflammation and injury of the Achilles tendon occur more often in people over the age of 30, and in a greater number of cases in men than in women. Because of the greater load, there is a higher degree of risk in obese people. Tendon inflammation often occurs in people who have flat feet, due to which the Achilles tendon is constantly tense. In those people who, along with flat feet, also have increased body weight, the pain will most often appear in the morning, immediately after getting up. The pain will then ease after a few steps.
Achilles tendon inflammation can occur due to training on an inadequate surface, such as artificial turf or concrete. It most often occurs in those people who run or do not do an adequate warm-up before the start of training. Also, steroid injections that doctors administer to reduce ankle swelling can contribute to weakening of the tendon and its rupture.
Achilles tendon inflammation - conditions
Excessive strain on the Achilles tendon first leads to small tears, and then to an inflammatory process which can most often be:
- When the inflammatory process is not stopped in time, chronic damage to the tendon known as Achilles tendinosis or tendinitis (tendinopathy) occurs. Due to prolonged loading, the tendon becomes thickened and nodules appear. It is a common occurrence in middle-aged athletes.
- Heavy strain on the Achilles tendon, rheumatoid arthritis, or a heel injury lead to bursa inflammation, causing retrocalcaneal bursitis or bursitis of the posterior part of the Achilles tendon. The bursa is a fluid-filled joint sac located between the posterior part of the heel bone and the Achilles tendon.
- Bursitis of the anterior part of the Achilles tendon – this is inflammation of the bursa located on the anterior part of the heel bone and the Achilles tendon.
- The combined action of several factors, such as an inadequate surface, heavy load during training, or insufficient rest, can cause Achilles tendinitis. This is an acute inflammation that leads to swelling and pain.
- An inflammatory process at the very attachment of the tendon to the heel bone is called Achilles enthesitis.
- Achilles paratenonitis is inflammation of the tissue surrounding the tendon, which can occur due to heavy strain, repetitive movements, or uncomfortable footwear.
Achilles tendon rupture
An Achilles tendon rupture (or rupture of the Achilles tendon) can be:
- partial or
- complete (total)
When it comes to an Achilles tendon tear, that is, a rupture of the Achilles tendon, those at greatest risk are athletes, as well as recreational athletes who started training suddenly, without prior preparation and stretching. Achilles tendon rupture in elite athletes generally occurs due to excessive load. A sudden injury can also occur due to other heavy loads during everyday activities. Apart from from strain, an Achilles tendon rupture usually occurs after an untreated inflammation or a minor injury.
An Achilles tendon rupture most easily occurs when tripping, walking on uneven terrain, or missing a step while walking downhill. It will occur more often in people with flat feet, less developed leg muscles, and those who suffer from rheumatic and similar diseases.
Physically active people will generally have complaints in the tendon closer to the muscle, that is, at the level of the calf muscle. In less physically active people, the pain appears closer to the point of attachment to the heel bone. Also, complaints closer to the heel bone are caused by rheumatic diseases and osteoarthritis (cartilage deterioration).
Achilles tendon rupture and inflammation - treatment
The diagnosis is usually established by an examination by a physiatrist or orthopedist and ultrasound imaging of the tendon (echosonographic imaging). The doctor will determine whether there are outgrowths, thickenings, or nodules, and may perform additional tests to definitively determine whether the Achilles tendon has ruptured. The best-known test is the Thompson test, which serves to determine whether the tendon is connected to the heel. Sometimes X-ray or magnetic resonance imaging is used in the diagnosis.
Treatment depends on the degree of injury, the patient’s general health condition and other diseases, as well as age. As with most injuries, treatment of the Achilles tendon can be surgical and non-surgical. Younger and physically active patients more often choose a surgical procedure in order to fully restore the torn tendon, while older patients choose non-surgical methods. Of course, the treatment method also depends on whether a partial or complete rupture of the tendon has occurred. In the beginning, cold compresses and pain medications can help temporarily.
In the case of a complete rupture of the tendon, it is necessary to perform surgery as soon as possible, and at the latest four weeks from the moment of injury, and to place the leg in a plaster cast for immobilization. The surgeon makes a small incision, joins the torn Achilles tendon, and ties the surrounding tendons. Possible complications may arise from nerve damage and infection in the postoperative period. After the cast is removed, rehabilitation begins, based on physical therapy, with special emphasis on kinesitherapy.
A partial rupture of the Achilles tendon is treated with immobilization or physical procedures. Whether the treatment is surgical or non-surgical, physical therapy is unavoidable. It usually includes hydrotherapy, laser therapy, ultrasound therapy, and electrotherapy. Kinesitherapy must be determined depending on the specific case and with constant supervision by a therapist. Eccentric exercises should also be done under the supervision of a physiotherapist at first; they involve stretching or contraction of the muscle.
The most common mistake in treating tendon inflammation is the application of intensive manual massages or therapies that lead to partial tearing of the tendon tissue.
Achilles tendon inflammation - natural treatment
Although there is no natural way for Achilles tendon inflammation to pass on its own, eating nuts can slightly ease the inflammation. Nuts, such as almonds or hazelnuts, contain a high level of vitamin E, which is a powerful antioxidant. Vitamin E helps neutralize the free radicals that cause inflammation. Of course, it goes without saying that treatment cannot be based solely on taking vitamin E; it is necessary to apply the prescribed therapy.
Achilles tendon - recovery
A return to physical activities is expected after a minimum of two to three weeks from the injury. With more severe injuries up to eight weeks of rest are needed. Although the period of immobilization in non-surgical treatment used to last as long as 12 weeks, today functional non-surgical treatment is applied. The treatment is based on short immobilization, followed by wearing an orthosis and physical therapy. The entire process lasts eight to ten weeks.
After a surgical intervention, rehabilitation of at least two months is required, and recovery will certainly depend on the degree of injury. Full recovery from surgery and more intensive physical activity is expected after four to six months. Muscle-strengthening exercises are extremely important because they shorten the recovery period.
Achilles tendon - exercises
We have selected two simple exercises for the Achilles tendon, but we remind you that, in the case of Achilles tendon inflammation, you should not do them on your own; instead, consult a physiotherapist. Perform the exercises without sudden movements, and if you feel pain, stop exercising immediately.
Achilles tendon exercise in a standing position
- Stand upright on a flat surface.
- Shift all of your body weight onto your heels. Lift your toes off the floor.
- Hold this position for 5 seconds.
- Return to flat feet, to the starting position.
Do the exercise in 3 sets of 10 repetitions
Achilles tendon exercise with a towel
- Sit on a hard, flat surface with your legs stretched out in front of you.
- Wrap a towel around the sole of your foot and hold the ends of the towel with both hands.
- Pull the towel toward your body so that the leg and knee remain straight and on the floor.
- Hold this position for 30 seconds.
- Repeat the exercise several times.
An Achilles tendon injury cannot be predicted, nor can it be prevented with preventive measures. The only thing we can do is to regularly stretch the muscles before and after training, avoid running uphill and running on uneven surfaces. It is important to gradually increase the intensity of training and to choose appropriate trainers depending on the type of sport involved.
Just as the Achilles tendon is key to every step, so daily care for your health is key to a life without pain. Call us and take the first step toward an easier and healthier life. We are available at the phone number 060/134-3303, and you can also write to us through the contact form below.
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Related services: for an Achilles tendon injury we recommend tecar therapy and electrotherapy. To make an appointment book an examination.