In the world of sports, few injuries are as notorious and debilitating as those affecting the Achilles tendon. But for the average person, Achilles injuries may not be top-of-mind.

However, Achilles tendon injuries are more common than you may think and can really sideline you from the activities you enjoy.

That’s why we spoke with Drew Stal, M.D., a foot and ankle orthopedic surgeon at Texas Health Orthopedic Specialists, a Texas Health Physicians Group practice, to get his insights on the importance of the Achilles tendon, common injuries, symptoms, treatments, and preventive measures.

What is the Achilles Tendon and Why is it Important?

Named after the legendary Greek hero Achilles, whose only vulnerable spot was his heel, this tendon connects the calf muscles to the heel bone and plays a crucial role in our ability to walk, run, and jump. Even simple, everyday activities like climbing stairs, playing sports, or dancing rely on the Achilles tendon. Without it, you wouldn't be able to push off the ground effectively, making it difficult to perform these actions.

The Achilles tendon also plays a key role in maintaining your balance. When you stand on your toes or push off the ground to take a step, the Achilles tendon helps keep you steady and balanced.

Common Achilles Injuries

Unfortunately, the Achilles’ pivotal function also makes it highly susceptible to injury. Although the Achilles tendon is the largest and strongest tendon in your body, and can handle a lot of force, if the tendon is weak or damaged, you’re more likely to experience problems like Achilles tendinitis or even a tendon rupture.

The three most common Achilles injuries are Achilles tendinitis, tendinosis and rupture.

“Achilles tendinitis is a common injury characterized by inflammation of the Achilles tendon, often caused by overuse, a sudden increase in activity, or tight calf muscles,” Stal explains. “Those suffering from Achilles tendinitis typically experience pain and stiffness along the tendon — or the back of the heel — especially in the morning or after exercising.”

Another prevalent injury is Achilles tendinosis, which involves the deterioration of the tendon due to chronic overuse. This condition arises from repeated stress on the tendon without adequate recovery time, leading to persistent pain, thickening of the tendon, and reduced strength.

The most severe of these injuries is an Achilles rupture, which is a complete or partial tear of the tendon. An Achilles rupture often occurs during sudden, forceful movements like jumping or sprinting, or from direct trauma.

“It’s not uncommon for patients to have underlying Achilles tendon issues that can predispose them to rupture,” says Stal. “This would include tendinitis and tendinosis.”

Symptoms of a rupture include a sharp pain or a popping sound at the time of injury, followed by difficulty walking and a noticeable gap in the tendon.

Who is at Risk for Achilles Injuries?

Achilles injuries can affect anyone, but they are especially common among athletes and individuals who engage in activities involving repetitive stress on the tendon. Runners, dancers, and those participating in sports like basketball or tennis are particularly at risk.

Age is also a factor, with injuries more common in middle-aged individuals due to the natural wear and tear of the tendon over time. Additionally, a sudden increase in physical activity or intensity can lead to injury.

“I often see patients who start up a new sport or increase their physical activity without easing into it, and they end up with Achilles inflammation. Worst case scenario, the tendon is so weak from inactivity, or the physical activity is so intense that they do experience a rupture.”

Symptoms of an Achilles injury can vary but typically include:

• Pain and stiffness along the Achilles tendon (back of ankle and/or calf), particularly in the morning or after periods of inactivity.
• Swelling or thickening in the tendon area.
• Limited range of motion when flexing the foot.
• Bruising and difficulty walking (especially in acute ruptures)
• Persistent pain despite rest and conservative treatments (in chronic conditions)

Achilles injuries often occur during activities that involve sudden changes in direction or intense physical exertion. But several factors can contribute to an Achilles injury:

Overuse: Repeated stress from activities like running or jumping can cause microtears in
the tendon.

Improper Footwear: Wearing shoes without proper support can increase strain on the Achilles tendon.

Ankle Stiffness: Having tight calf muscles can place increased stress on the Achilles tendon and its insertion on the heel bone, leading to inflammation.

Poor Training Practices: Inadequate warm-up, sudden increase in activity intensity, or lack of flexibility can elevate injury risk.

Age and Gender: Middle-aged men are particularly prone to Achilles tendon issues.

Medical Conditions: Conditions such as obesity, high blood pressure, and diabetes can weaken the tendon.

Previous Injuries: A history of Achilles tendon problems can make re-injury more likely. 

Treatment Options for Achilles Injuries

According to Stal, treatment for Achilles injuries varies depending on the severity:

• Rest and Ice: Reducing activity and applying ice can help manage pain and swelling.
• Medications: Over-the-counter pain relievers, such as ibuprofen, can alleviate discomfort.
• Orthotics: Shoe inserts can provide additional support and reduce strain on the tendon.
• Surgery: In severe cases, particularly with a rupture, surgery may be required to repair the tendon.

“I recommend seeking care right away if there is any suspicion of a rupture,” Stal says. “For minor injuries and/or chronic conditions, I would recommend seeking care if your symptoms persist and do not improve after a period of rest, icing the area, oral or topical anti-inflammatories and activity modification.”

Stal notes that physical therapy, while required for surgical interventions, may also be suggested to help with minor injuries or stubborn chronic conditions.

Early-stage physical therapy focuses on gentle ankle range of motion exercises to prevent stiffness. Gradually, strengthening exercises, including eccentric and concentric movements, are introduced to restore muscle strength and tendon function.

“I even have some patients who wear an orthopedic walking boot for a few days or a week and it helps them isolate that injury and get that inflammation down so they can get back to their daily activities,” he says. “Treatment really depends on your history and the extent of the injury.”

Preventing Achilles Injuries

Preventing Achilles injuries is crucial for maintaining mobility and avoiding pain and discomfort. Stal recommends implementing specific strategies to significantly reduce the risk of injury to the Achilles tendon.

Proper Warm-Up

Why It Matters: Warming up increases blood flow to the muscles and tendons, enhancing their elasticity and reducing the likelihood of strains and tears.

How to Do It:

• Dynamic Stretching: Perform dynamic stretches such as leg swings, walking lunges, and high knees to activate the muscles and prepare them for more intense activity.
• Gradual Increase in Intensity: Start with light aerobic exercises like brisk walking or slow jogging for 5-10 minutes before transitioning to more strenuous activities.
• Focus on Calves: Include specific warm-up exercises for the calf muscles, like calf raises or heel drops, to directly prepare the Achilles tendon for activity.

Gradual Increase in Activity

Why It Matters: A sudden increase in exercise intensity or duration can overload the tendon, leading to microtears and inflammation.

How to Do It:

• Follow the 10% Rule: Increase your activity level, whether it's running distance or weightlifting load, by no more than 10% per week.
• Pace Yourself: Avoid trying to achieve too much too quickly. Allow your body time to adapt to new levels of physical stress.
• Rest and Recovery: Ensure adequate rest days between high-intensity workouts to give the tendon time to recover and strengthen.

Regular Stretching

Why It Matters: Stretching helps maintain the flexibility of the calf muscles and Achilles tendon, reducing the risk of strain and injury.

Effective Stretching Techniques:

• Calf Stretch: Stand facing a wall with one foot forward and the other back, keeping both heels on the ground. Lean forward to stretch the calf of the back leg. Hold for 20-30 seconds and switch sides.
• Heel Drop: Stand on a step with the balls of your feet on the edge and your heels hanging off. Lower your heels below the step level to stretch the Achilles tendon and calf muscles. Hold for 20-30 seconds.
• Foam Rolling: Use a foam roller on your calves to release muscle tightness and improve flexibility.

Strength Training

Why It Matters: Strengthening the muscles around the Achilles tendon can help absorb impact and reduce strain on the tendon itself.

Key Exercises:

• Calf Raises: Stand on a flat surface or step and raise your heels as high as possible, then slowly lower them back down. Perform 3 sets of 10-15 repetitions.
• Eccentric Heel Drops: Stand on a step with your heels hanging off. Raise up on both feet, then shift your weight to one foot and slowly lower your heel below the step. Perform 3 sets of 10-15 repetitions on each leg.
• Seated Calf Raises: Sit with your feet flat on the ground and a weight resting on your thighs. Raise your heels off the ground, hold briefly, and then lower them back down. Perform 3 sets of 10-15 repetitions.

The Takeaway

The Achilles tendon plays a vital role in your mobility and daily activities. Understanding its importance, the risks of injury, and how to manage and prevent issues can help maintain your overall health and well-being.

Find a foot and ankle specialist today who can assist with your joint pain.