Common injuries of the Achilles tendon that affect active people

The Achilles tendon can be the source of pain for many active people. Runners often face problems related to their Achilles tendons. A variety of conditions of this tendon can cause ankle pain and limit physical activity. This article reviews some of the causes of Achilles tendon problems.

Achilles tendon rupture

Rupture of the Achilles tendon can occur in the setting of pre-existing disorders of the tendon, such as Achilles tendinopathy. An active person can tear the Achilles tendon without any underlying issues of the tendon. He can rupture the tendon after a sudden event in sports, such as quickly starting to sprint or pushing off awkwardly. The athlete might feel as if someone kicked him in the back of the ankle, as he feels a sharp, sudden pain.

Achilles tendon ruptures are painful traumatic injuries that often lead to surgery for athletes and active individuals. On the other hand, some people can have good outcomes without surgery. The patient can wear a cast on her foot and ankle for many weeks. Once the tendon has healed sufficiently, she can gradually increase weight-bearing and range of motion. Many orthopedic surgeons feel that healing rates with nonoperative treatment approach those with surgical treatment.

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Episode 99: Why are Achilles tendon ruptures such devastating injuries for athletes?

Illustration of an Achilles tendon rupture

Achilles tendinitis

This is a cause of pain within the substance of the Achilles tendon above its insertion. It affects active people and usually results from overuse. Rest, activity modification, anti-inflammatory medications, ice, and eccentric exercises at home or in physical therapy are often helpful.

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Achilles tendinopathy

Achilles tendinopathy is often a chronic cause of Achilles tendon pain. It can be related to overuse in sports or exercise. A small area of degeneration can develop within the tendon. It can appear as partial tearing of the tendon. Sometimes palpable nodules develop within the tendon. Rest from the offending activity or exercise can be helpful for some patients. Physical therapy can also be helpful. If symptoms do not improve, orthopaedic surgeons might try more aggressive treatments like platelet-rich plasma or even surgery.

Achilles paratenonitis

This term and diagnosis refers to inflammation of the sheath that covers the Achilles tendon. The patient might notice pain with ankle motion as the tendon moves within the inflamed sheath.

Insertional Achilles tendinitis/tendinopathy

This is degeneration or partial tearing of the Achilles tendon as it inserts into the calcaneus (heel bone). Runners with this problem can be fairly debilitated. Physical therapy might be helpful, especially for active individuals. Occasionally orthotics or shoe inserts can be used as well. Occasionally surgery is needed for patients not improving after many months of treatment.

Retrocalcaneal bursitis

A bursa (fluid-filled sac) lies between the attachment of the Achilles tendon to the calcaneus and the bone itself. Inflammation of this bursa causes pain and swelling on the back of the heel, especially with activity.

Location of Achilles tendon pain

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