Achilles Tendon Injuries

The Achilles tendon, also called the calcaneal tendon, is the strongest and thickest tendon in the body. The Achilles tendon is formed where the gastrocnemius and soleus muscles (the calf muscles) join into one band of tissue at the lower end of the calf. This tough band of fibrous tissue connects the calf muscles to the heel bone, and is critical for activities like walking, running, jumping, standing on the toes, and climbing stairs. When walking, the Achilles tendon is able to withstand four times a person’s body weight. When climbing stairs or running, the Achilles tendon is able to withstand at least 10 times a person’s body weight.

  • Achilles tendon tear: tears can be microscopic, or large, and can result in pain, swelling, and impair movement. Tears to the Achilles tendon can happen suddenly during activity, or gradually over time.
  • Achilles tendon rupture: a complete tear of the tendon may make a “pop” sound, followed by pain and swelling of the lower leg. Treating an Achilles tendon rupture requires surgery or long-term immobilization of the ankle.
  • Achilles tendinitis: repetitive stress, or overuse, to the Achilles tendon from frequent activities such as running or walking can gradually inflame the tendon, causing pain and stiffness at the back of the heel. Rest, ice, and stretching can help relieve the inflammation.

Injuries to the Achilles tendon might be caused by:

  • Overuse, or increasing your activity level too quickly
  • Not warming up or stretching before exercise or activity
  • Wearing high heel, which increases stress on the Achilles tendon
  • Other foot related conditions, such as flat feet

Achilles tendon injuries are common in sports, such as: running, gymnastics, dancing, football, and tennis.


Sign and symptoms of an injury to the Achilles tendon might include:

  • Pain along the back of your foot and above the heel, especially when stretching or standing on your toes. Pain might be mild and worsen gradually with tendinitis, or pain can be sudden and severe if the tendon has ruptured.
  • Tenderness
  • Swelling
  • Stiffness
  • Difficulty flexing the foot or pointing the toes
  • Snapping or popping was heard or felt at the time of injury

Treatment options for injuries to the Achilles tendon vary depending on the severity of the injury. Mild –to-moderate injuries should heal on their own with time and care. An easy self-care treatment option is the RICE method:

  • Rest: avoid putting unnecessary weight or stress on the leg
  • Ice: 20 to 30 minutes every 3-4 hours until pain and swelling are gone
  • Compression: wrap an elastic bandage around the lower leg and ankle to keep down swelling
  • Elevate: keep the leg elevated on a pillow while you are sitting or lying down
  • Anti-inflammatory pain medication: NSAIDs like ibuprofen or aspirin will help with pain and swelling
  • Heel lifts: shoe inserts help protecting the Achilles tendon from further stretching
  • Physical Therapy: when recommended by your physician can help strengthen muscles that support the Achilles tendon

Severe injuries of the Achilles tendon may require surgical intervention. During surgery, the ruptured Achilles tendon is sewn back together. Patients will wear a cast or boot for the first 6 to 12 weeks. Immediately after surgery, the cast or boot is positioned to keep the foot pointed downward as the tendon heals. The cast or boot will be adjusted gradually to put the foot in a neutral position. Total recovery time following an Achilles tendon repair is about 6 months, but it may take up to a full year before some patients completely recover. Physical therapy also plays an important role in recovery. Therapy will help patients regain strength and flexibility in the injured leg.