In Greek mythology, Achilles’ mother, Thetis, dipped him in the River Styxx as an infant in order to give him the power of invulnerability. But Thetis forgot one thing—his feet. Unfortunately, things didn’t end well for Achilles, and he suffered a deadly blow to his heel in battle.
Here in the real world, although it is strong, our Achilles tendon remains a vulnerable spot for us too.
The Achilles tendon is the thickest and strongest tendon in the body. Coming in at about six inches in length, it has the important job of connecting the calf muscle to the heel bone. Whether you’re out on a leisurely stroll or running, jumping or doing push-ups, your Achilles tendon is working hard to endure the load and stress we put on it.
But if it’s placed under too much stress, the tendon can tighten and overwork itself, which can lead to an overuse injury such as Achilles tendinosis.
To better understand this overuse injury, we asked Joseph Blazuk, MD, an orthopedic sports medicine physician with TOCA at Banner Health in Arizona, to break down the causes and treatment options for tendinosis and how to prevent further damage.
What is Achilles tendinosis?
Much like other overuse injuries such as shin splints, Achilles tendinosis is the result of chronic overuse. It can be due to a volume issue where you simply place too much load repeatedly through the tendon (like distance running) or, more commonly, poor alignment, muscle imbalance and calf tightness can accelerate wear on the tendon.
Typically, it will present as Achilles pain that worsens during activity—sometimes squeezing the tendon is painful, and in bad cases, you can even see noticeable thickening of the tendon.
“Tendinosis implies disorganization and disarray, much like an old ratty rope where fibers are thickened and frayed, or a paint brush with dried paint on the ends where we lose the fiber organization,” Dr. Blazuk said.
What causes Achilles tendinosis?
If you have very high-arched feet, tight calf muscles and/or overpronate (i.e., feet roll inward and flatten out more than normal with walking/running), you’ll be more predisposed to Achilles tendon injury. Certain medications such as fluoroquinolone antibiotics (Cipro, Levaquin) can place the tendon at risk as well as any cortisone injections in the vicinity of the tendon. Inflammatory arthritis (such as rheumatoid arthritis), thyroid disease and diabetes are systemic issues that may also increase the chance of Achilles tendon injury.
How is tendinitis different from tendinosis?
Many people still call their tendon pain tendinitis, which means acute inflammation of the tendon, but researchers say this is no longer accurate.
“Tendinitis implies 'acute' inflammation, but when we look under a microscope at tendinopathic tendons, we don't see cells characteristic of an acute inflammatory response, so tendinosis or tendinopathy has become the more accurate term,” Dr. Blazuk said.
What is an Achilles tendon rupture?
Achilles tendon ruptures occur when the tendon fibers tear and separate completely. In order for it to rupture, a sudden force is usually exerted on the tendon, often unexpectedly.
“Your 'weekend warriors' typically suffer these injuries, with rupture most frequently occurring in men in their 30s to 50s,” Dr. Blazuk said. “Rupture tends to occur with a very forceful push-off or while landing from a jump.”
When it ruptures, some people hear a snap or pop and feel like someone kicked them in the Achilles. However, a calf strain is an injury with similar symptom that overlap, though typically that pain is higher up along the calf as opposed to along the Achilles tendon.
“One way you can distinguish at home is to lay on your belly, bend your knees to 90 degrees and have someone look to see if the affected side foot points down compared to the normal side,” Dr. Blazuk said. “If so, there is a good chance we are dealing with a rupture versus a calf strain.”
How is Achilles tendinosis treated?
If you notice tendinosis pain is starting to affect your recreational activities, it may be time to see your doctor. Treatment will depend on the type and the severity of your injury, but typically your doctor will start you out with a stretching program and physical therapy.
For ruptures, your doctor may immobilize the area by treating with a walking cast for 6-12 weeks or repair through surgery. Dr. Blazuk said the outcomes and return to activity are about the same for both.
“The traditional school of thought is that the rupture risk is lower in folks who elect surgical repair, but some data suggests this may no longer be true,” Dr. Blazuk said. “This is a conversation worth having with your surgeon if there is an acute rupture.”
How can I prevent injury?
Don’t ignore the warning signs and power through the aches and pain. Here are some things you can do to prevent Achilles tendinosis from occurring:
- Properly warm-up before ramping up exercise
- Stretch the calf/heel cords after exercise or in between sessions
- Wear doctor-prescribed orthotics or shoe inserts
Find a Doctor
Are you experiencing pain in your Achilles tendon? Schedule an appointment with a Banner Health expert who can help determine the cause of your pain, get you treated and back to exercise. Visit bannerhealth.com to learn more.