Achilles tendon

We want you on your feet again

When you climb stairs, your Achilles tendon can easily be subject to pulling forces of up to 500kg. The Achilles tendon is actually the strongest tendon in the whole body, but high stresses frequently cause issues.

Achilles tendon pain can be difficult to manage and often needs the expertise of physiotherapists, podiatrists, orthopaedic surgeons and sports medicine doctors in a multidisciplinary team.

At Schoen Clinic, we carefully assess your symptoms, and using our diagnostic imaging suite, we are able to provide you with a rapid and accurate diagnosis. We also have a state-of-the-art 4D Gait Scanner that can detect the underlying mechanics that have led to your Achilles problems.

What Achilles tendon injuries are there?

The Achilles tendon can be damaged in different ways. It may be hurting due to a gradual pathological process of tendinopathy or may acutely rupture.
With an Achilles tendon rupture, it can be a sudden injury which may occur in the middle of the tendon or sometimes where the tendon meets the calf muscle. The Achilles is the largest tendon in the body and the rupture can be very painful.

Tendinopathy of the Achilles refers to a wear and tear process that can affect the tendon either in its middle (mid-substance tendinopathy) or where it attaches to the bone (insertional tendinopathy). With insertional tendinopathy, the region where your tendon enters the bone is inflamed. If long-term Achilles tendon changes occur, painful calcifications can build up inside your tendon. These may appear as a bony bump on the back of your heel or as a bony ledge on the top of your heel bone, this is called a Haglund’s deformity. Most often, this also involves a chronically inflamed bursa. The long-term inflammatory irritation leads to further bone growth as well as the formation of scar tissue. This causes your heel to become thicker and pain to increase.

Symptoms: Signs of an Achilles tendon injury

With an Achilles tendon rupture, your tendon is usually torn with a jerky movement and a loud noise similar to the crack of a whip. This can be very painful and often patients think that the back of their heel was hit by another player or a ball.

In a chronic tendinopathy either your Achilles tendon itself or the area where the tendon enters the bone will be painful. Wear-related Achilles tendon injuries are accompanied by pain when initiating movement, this means there will be more pain when starting an activity. Once your tendon has “warmed up”, the pain will decrease. For this reason, your tendon may hurt more again after sports.

Insertional tendonitis and Haglund’s deformity almost always cause conflicts with your footwear due to chronic Achilles tendon inflammation. The bony ledge on the heel bone presses against the insertion point of the tendon, which is most painful when wearing closed shoes. With a partial or complete rupture, those affected report a feeling of severe “stabbing” pain, they can no longer stand on their tiptoes and sports are completely out of the question.

Chronic Achilles tendon changes often involve a thickening of the middle section of the tendon. If your tendon is ruptured, you will be able to feel a dent.

Causes: how does an Achilles tendon injury occur?

The Achilles tendon is subject to high stresses each day and as a result, issues in this area are very common. Overuse injuries in repetitive endurance sports or those with an underlying biomechanical issue are at risk, such as:
  • Sporting activities, typically a lunge and a contraction of the tendon whilst the calf muscle is lengthening as well as contracting, known as an eccentric contraction
  • During a fall
  • In some cases, it may be secondary to chronic irritation such as spondyloarthropathy or rheumatic arthritis, which thicken and soften the Achilles tendon in the region before it enters the h
  • Sports which incorporate quick changes in direction, such as football, tennis and squash, carry the biggest risk of injury
  • Painful bursa inflammation
  • Relatively small tensile movements
  • When restarting sports activities after a long break
  • Some antibiotics and cortisone preparations can change the tendon structure and therefore weaken the Achilles tendon when taken over long periods of time

Precise diagnostics for the right treatment

Because the Achilles tendon can be damaged in many different ways, the therapy will vary slightly from patient to patient. Your individual therapy is based on your specific injury and tailored to you. Therefore, during our diagnostics, we will ask questions enabling you to clarify precisely how your injury occurred and what caused it.

Proven methods: Ultrasound and MRI

X-ray images only show changes that indicate the corresponding injury in the case of Haglund’s deformity and insertional tendonitis. For Achilles tendon injuries, our specialists often use ultrasound scans to diagnose ruptures. We also opt for MRI scans particularly for wear-related changes, which allow us to clearly see which regions of the tendon have changed.

The best-possible therapy for your Achilles tendon

Whether rupture, inflammation or calcification, Achilles tendon injuries and disorders are often painful and long-lasting. Thanks to our precise diagnostics, we offer you the best possible treatment at Schoen Clinic. Depending on the type and severity of your symptoms, a full range of options are available. We can provide conservative management to treat an Achilles rupture without the need for an operation, to Achilles tendon surgery or reconstruction of a deficient Achilles tendon. We will ensure you get the right treatment for you.

Conservative therapy without surgery

Our multidisciplinary teams can help manage your tendon pain. In conjunction with physiotherapists and experts in sports and exercise medicine we can manage your Achilles pain with rehabilitation, orthotics, shockwave therapy, Platelet Rich Plasma (PRP) or high-volume injections.

If your symptoms persist, our specialists can manage them with surgery to remove the painful tissue, or any prominent bone spurs through Achilles tendon surgery or Haglund decompression. Occasionally, inflammation occurs between the Achilles and another smaller tendon called the plantaris, which can be treated surgically with good results.

Achilles tendon: Our specialists

Schoen Clinic has highly experienced specialists, experts in treating all aspects of foot injury. With a multidisciplinary team and a data driven approach to quality outcomes and care, we ensure you get the best possible outcome from your treatment. 

Dr Roger Wolman

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant - Rheumatology

Consultant - Sports & Exercise Medicine

Consultant Rheumatology and Sport & Exercise Medicine
MD (Res) FRCP FFSEM
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Mr Ali Abbasian

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant Orthopaedic Surgeon - Foot & Ankle

Consultant Orthopaedic Surgeon 
MBBS FRCS(Tr&Orth)
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Mr Kumar Kunasingam

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant Orthopaedic Surgeon - Foot & Ankle

Consultant Orthopaedic Surgeon
BSc(Hons) MBBS(Eng) MRCS(Eng) FRCS(Tr&Orth) DipSEM DipOrth
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Mr Aswinkumar Vasireddy

Consultant Orthopaedic Surgeon - Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant Orthopaedic Trauma Surgeon
BSc(Hons) MBBS MRCS(Eng.) Dipl.Tr&Orth FRCS(Tr&Orth)
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Mr Stefan Weitzel

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant Orthopaedic Surgeon - Foot & Ankle

Consultant Orthopaedic Surgeon
MD FRCS(Eng) FRCS(Tr&Orth)
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Dr Philip Batty

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant - Sports & Exercise Medicine

Consultant Sport and Exercise Physician
MB ChB, MRCGP, FFSEM
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Achilles tendon: Our specialised hospital

Schoen Clinic is an acutely specialised Orthopaedic and Spinal Hospital in the heart of London. We can provide leading surgeons, a state-of-the-art imaging suite for diagnostics, experts in injury prevention, treatment and rehabilitation with a caring, compassionate culture, which guarantee you are in safe hands. 

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Authors, 09.06.2020