Causes and Symptoms
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, your tendon will suddenly rupture. This 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. Which may appear as a bony bump on the back of your heel.
There may be a bony ledge on the top of your heel bone causing irritation of the tendon insertion, this is called a Haglund’s deformity. Most of the time, 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.
How does an Achilles tendon injury occur?
The Achilles tendon is subject to high stresses each day. 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.
An Achilles tendon rupture can be caused by 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. A rupture can also happen 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 heel bone. In addition, painful bursa inflammation frequently occurs. Even relatively small tensile movements can cause an Achilles tendon rupture.
An Achilles tendon rupture most often occurs when restarting sports activities after a long break. Sports which incorporate quick changes in direction, such as football, tennis and squash, carry the biggest risk of injury.
Furthermore, some antibiotics and cortisone preparations can change the tendon structure and therefore weaken the Achilles tendon when taken over long periods of time.
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. 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 their tendon being stabbed with a knife. 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.