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When do Achilles tendon injuries occur?

Normal Achilles tendons can support a significant amount of force, but when this is put under sudden loading, especially after a gap from activities, injury to the tendons can happen. Some people have pre-existing tendonitis from repetitive spraining and healing of the tendon due to overuse, which makes them susceptible to further tearing. Occasionally, steroid injections around the tendon could lead to rupture.

For example, if an individual suddenly returns to football or racquet sports after a long period of absence, the frequent pivots and changes of direction, and sudden acceleration and deceleration, will put the Achilles tendon under a huge amount of strain which can result in a tear.

What actually happens when the injury occurs?

Patients feel a snap or sudden giving way. A common description from patients has been feeling the injury happen and looking back to see if there was a physical impact, as if someone threw a racquet or kicked you in the leg. We have heard stories of doubles partners in tennis being blamed unfairly! Surprisingly, many patients can walk or limp straight after the injury but could not play. The lack of connection between the knee and ankle can be disconcerting but some ruptures could be missed as the individual is still able to walk. Noticeable swelling and bruising tend to occur a little later.

Are there different types of tendon injury and treatment?

The two main types of Achilles tendon injuries can be categorised as muscle tears, or partial or complete tendon tears. Clinical assessment can confirm a gap in the tendon. A calf squeeze test shows lack of foot movement compared to the opposite side – the difference is often quite striking but needs a dynamic ultrasound test to confirm the tear, level, extent and gap.

Initial treatment is with partial plaster or a boot with a number of heel wedges. At this stage, the patient should have an informed discussion on the options of non-operative vs surgical treatment. Recent evidence suggests both options are good; however, every patient should be individually considered according to the level of function, sports, and choice. Recovery time varies between 6-10 weeks for complete ruptures.

 

How can I prevent Achilles tendon injuries?

The best preventative measure you can take is to really focus on your warm-up. It is so important to ease back into a routine, particularly if you have taken a break from previous sports activity. Making the time to stretch and do some mobility work before a training session or match will pay dividends in the long run.

 

Written by Mr Pal Ramesh, consultant Orthopaedic Surgeon at OneWelbeck Orthopaedics with special interest problems of the foot and ankle problems including sports injuries, tendon repair and ligament reconstruction.