What To Expect If You Have An Achilles Tendon Injury

The Achilles tendon is the largest and strongest tendon in your body, which plays a critical role in everyday movements like walking, running, and jumping. However, due to its frequent use and significant load-bearing function, it is also quite prone to injuries. Whether you’re an athlete or someone with an active lifestyle, an Achilles tendon injury can cause significant pain and mobility challenges. Achilles tendon injuries can become quite painful and cause discomfort in performing daily activities.

This article explores everything you need to know about Achilles tendon injuries, from causes and symptoms to effective treatments and recovery tips in Singapore.

What is an Achilles Tendon Injury?

To understand the Achilles tendon injuries, it is important to first understand the anatomy of the leg and foot. The Achilles tendon connects the calf muscles to the heel bone and allows you to push off the ground while walking or running. An injury to this tendon can occur due to overuse, trauma, or sudden stress. These injuries can range from mild inflammation to complete rupture.

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Common Causes of Achilles Tendon Injuries

Although the Achilles is quite strong and can withstand a lot of stress as you perform different activities, there are certain factors that cause it to become damaged. These causes include:

1. Overuse and Repetitive Strain: Activities like running, jumping, or intense sports can strain the tendon over time, leading to inflammation or degeneration.
2. Sudden Increase in Physical Activity: Increasing workout intensity without proper conditioning can overload the tendon.
3. Improper Footwear: Wearing shoes without adequate arch support can strain the Achilles tendon.
4. Ageing: Tendons lose flexibility with age, making them more prone to injuries.
5. Underlying Conditions: Conditions like flat feet, high arches, or obesity can contribute to increased stress on the tendon.
6. Having a condition called Haglund’s deformity where the bone at the back of the heel becomes enlarged and pushes or rubs the Achilles tendon. This causes the tendon to become inflamed and causes pain.

Symptoms of an Achilles Tendon Injury

Recognising the symptoms early can help in timely treatment and recovery:

• Pain and Stiffness: Typically felt at the back of the heel or lower calf, especially after exercise.
• Swelling: The tendon may appear swollen or thickened.
• Tenderness: Sensitivity to touch along the tendon area.
• Difficulty Moving the Foot: Reduced range of motion, making activities like climbing stairs or running painful.
• Audible Snap: In severe cases like a rupture, you may hear a popping sound followed by sudden sharp pain.

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Types of Achilles Tendon Injuries

Achilles Tendinitis

Achilles tendonitis is the condition that occurs when the Achilles tendon becomes inflamed or irritated. This inflammation is usually caused by overuse or repetitive strain. This condition is often seen in runners or athletes who increase training intensity too quickly. Tendinitis is also closely related to tendinopathy, which refers to the microscopic degeneration of the tendon due to chronic damage over time. Depending on the location where the tendon gets inflamed, we can further divide this condition into two sub-categories.

Noninsertional Achilles Tendonitis

In noninsertional Achilles tendonitis, the middle part of the tendon above the heel gets inflamed or irritated. The fibres of the tendon may degenerate over time and tear, causing swelling and pain in the area. This type of tendonitis is most common in young individuals and athletes.

Insertional Achilles Tendonitis

Insertional Achilles tendonitis refers to the inflammation of the tendon at the point where it attaches to the heel bone. This type of tendonitis can result in the forming of bone spurs on the heel. This condition is most common in runners but can happen to anyone. One of the main causes of insertional Achilles tendonitis is tightness in the calf muscles that places increased stress on the tendon at the point where it attaches to the heel.

Achilles Tendinosis

Achilles Tendinosis is a degenerative condition that results from untreated tendinitis, leading to micro-tears and scarring. With time, the tendon becomes weak and is prone to rupture.

Achilles Tendon Rupture

An Achilles rupture is a condition that occurs when the tendon gets separated from the heel bone completely, or the tendon gets torn in half from any other place. The complete tear of the tendon is often caused by sudden, forceful movements. This kind of rupture occurs in case of an acute injury or trauma and can result in severe pain and an inability to walk. You may hear a popping sound when the tendon ruptures, followed by extreme pain. This condition requires immediate medical attention and may necessitate surgery.

Who is at risk of developing an Achilles Tendon Injury?

Although anyone can develop a tendon injury, there are certain risk factors that may increase your chances of injuring your Achilles tendon. These include:

• Repetitive motions that strain the calf muscles
• Overuse of the tendon.
• Doing high-impact activities and exercise without warming up first
• Treatment with an antibiotic called fluoroquinolone. 
• People who have tight calf muscles and flat arches in the foot are more at risk of getting these conditions. 

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When to See a Doctor For An Achilles Tendon Injury In Singapore

Consult a healthcare professional if:

• Pain persists despite rest and home remedies.
• You experience severe swelling, difficulty walking, or a sudden inability to push off the ground.
• There is a visible deformity or a lump in the tendon area.

Diagnosis of Achilles Tendon Injuries

If your orthopaedic doctor suspects an Achilles tendon injury, he may carry out the following steps to confirm the diagnosis.

• The doctor performs a physical exam to check for tenderness, swelling, and range of motion in the ankle, foot, and adjoining areas. The doctor may carry out the following tests for Achilles tendon injury:
  • Range of motion test
    • Point your toes downwards and then upwards while seated
    • Pay attention to any pain or limitations in your range of movement.
  • Strength test
    • Stand up and rise up on your tiptoes using your uninjured leg.
    • Do the same on your injured leg and spot the difference.
• The doctor may order the following imaging tests to confirm the diagnosis:
  • Ultrasound: To assess tendon tears and inflammation.
  • MRI: For detailed imaging of the tendon structure.
  • X-rays: To rule out other issues like bone spurs.

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Treatment Options in Singapore for Achilles Tendon Injuries

Depending on the diagnosis of the Achilles tendon injury, the doctor may order any of the following treatment options.

Non-Surgical Treatments (For Mild to Moderate Injuries)

1. R.I.C.E. Method:
   • Rest, Ice, Compression, and Elevation to reduce swelling and pain.
2. Physical Therapy:
   • Stretching and strengthening exercises to improve flexibility and rebuild strength.
3. Orthotics and Footwear:
   • Use heel lifts or custom insoles for better support.
   • Your doctor may recommend wearing a night splint while sleeping at night. These are removable braces that can help hold your foot in place while you sleep
4. Medications:
   • Over-the-counter pain relievers like ibuprofen to reduce inflammation.
5. Extracorporeal Shockwave Therapy (ESWT):
   • Low or high-intensity shockwaves are administered to the Achilles tendon to promote healing. 
6. PRP Injections
   • PRP injection is administered directly into the tendon where it can promote healing and consequently reduce pain.

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Surgical Treatments (For Severe Cases)

If the Achilles tendon injury is too severe, which cannot be treated with conservative measures or if all conservative measures have been exhausted without significant pain reduction or healing of the affected tendon, the doctor may recommend surgery. Non-surgical treatment methods are given a chance for at least 6 months before considering surgical intervention. Depending on the location and severity of damage done to the tendon, your orthopaedic doctor in Singapore may recommend one or more of the following surgical procedures.

Debridement

Debridement is a surgical procedure that refers to the removal or cleaning up of damaged tissues of the Achilles tendon. This procedure may be performed for insertional Achilles tendonitis in which bone spurs formed in the heel are removed. Moreover, any damaged part of the tendon is removed and the remaining part of the tendon is reattached to the heel bone through stitches or anchors. This procedure has shown positive outcomes where the patients are able to walk after a few weeks of surgery while wearing a specialised boot or cast.

Gastrocnemius Recession

One of the main reasons for Achilles tendon injuries is the tight calf muscles (the gastrocnemius muscles) that put added stress on the tendon. Gastrocnemius recession is a surgical procedure that refers to the lengthening of the calf muscle in order to reduce stress on the affected tendon. This procedure may be recommended for patients who have tight calf muscles in spite of doing calf stretches. 

Achilles Tendon Rupture Repair Surgery

In case the Achilles tendon has been ruptured, the surgeon will carry out a tendon repair surgery. There are three different types of tendon rupture repair surgeries:

Percutaneous Achilles Repair

During a Percutaneous Achilles repair procedure, the surgeon makes tiny incisions along the length of the calf and inserts thin surgical instruments through these incisions. He then removes any damaged tissues of the Achilles tendon before attempting to repair the torn or ruptured parts. Using thin needles and sutures, the surgeon stitches the torn parts of the tendon together or attaches the ruptured tendon back to the heel bone. If needed, he may use screws and anchors to attach the tendon to the heel bone. In the end, the incisions are closed up with sutures. This procedure is minimally invasive and results in faster healing and recovery.

Open Achilles Repair

In an open Achilles repair procedure, the surgeon makes a relatively big incision at the back of the calf and tries to repair the torn parts of the Achilles tendon. Any damaged tissues of the tendon are first removed followed by stitching the torn parts of the tendon together through sutures. In case the tendon has ruptured completely from the heel bone, high-strength sutures and surgical screws may be used to attach the tendon back to the heel bone. In the end, the incision on the leg is stitched together. Since in this procedure, a large incision is made, it can result in relatively slower healing and recovery.

Tendon Transfer

If the damage to the Achilles tendon is too severe and the rupture has caused the tendon to become too short that it cannot be stitched together, the surgeon may transfer some other tendon from the body and attach it to the Achilles. The flexor hallucis longus tendon, which is present underneath the big toe, is often used for this tendon transfer. The surgeon removes this tendon and attaches it to the Achilles tendon at one end and the heel bone at the other end. Sutures and screws are used to anchor the tendon in place. The incisions are closed at the end after which the ankle and calf start to heal.

Surgical Biologics

Your surgeon may place a collagen patch on the Achilles tendon during your surgical procedure to further promote healing and help with recovery. Collagen is a protein that is present in our bodies and is a vital element of tendons and ligaments. When a collagen patch is put directly on the Achilles tendon, it promotes repair and healing at a cellular level. These collagen patches are quite effective in tendon repair, however they cannot rejuvenate the damaged tissues. With time, these patches dissolve and there is no need to remove them.

Hydrocision TenJet

This is a minimally invasive technique in which ultrasound-guided high-velocity saline is used to break up the damaged or scar tissue in the tendon. The unhealthy tissue is then removed through tiny incisions in the calf.

Rehabilitation and Recovery

Recovery from an Achilles tendon injury varies depending on the severity of the injury and the treatment approach:

• Non-Surgical Recovery:
  • Typically, it takes 6–12 weeks to recover from the injury after non-surgical treatment. However, regular physiotherapy must be carried out to ensure smooth recovery during this period.
• Post-Surgery Recovery:
  • In case of surgical treatment, full recovery may take 6–12 months after the surgery. Your doctor will recommend that you gradually return to physical activities, depending on your condition and recovery progress.

Preventing Achilles Tendon Injuries

There are some practical ways in which you can prevent Achilles tendon injuries. 

1. Warm-Up Before Exercise:
   • Proper warm-ups and dynamic stretches can reduce stress on the tendon.
2. Strengthening Exercises:
   • Include calf raises and eccentric loading exercises to strengthen the tendon.
3. Wear the Right Shoes:
   • Opt for footwear with good arch support and cushioning.
4. Avoid Overtraining:
   • Gradually increase workout intensity and incorporate rest days.
5. Cross-Training:
   • Mix high-impact activities with low-impact ones like swimming or cycling.

Living with Achilles Tendon Injuries: Lifestyle Adjustments for Long-Term Tendon Health

• Maintain a healthy weight to reduce stress on the tendons.
• Incorporate flexibility exercises like yoga or Pilates into your routine.
• Stay hydrated and follow a balanced diet rich in collagen-supporting nutrients.

Conclusion

Achilles tendon injuries can be debilitating but are preventable and treatable with the right approach. Whether you’re dealing with mild tendinitis or recovering from an Achilles tendon rupture, early diagnosis and appropriate care are key to a full recovery. Ray of Health is a comprehensive musculoskeletal health service provider that offers a wide range of diagnosis and treatment options, including foot pain treatment, meniscal injuries, ACL tears, shoulder pain, and many other orthopaedic conditions. By getting in touch with our qualified specialists, you can start your journey towards a life of pain relief. Contact Ray of Health today for any queries about Achilles tendon injuries or other orthopaedic conditions.

Frequently Asked Questions

Can I continue exercising with an Achilles tendon injury?

If you are suffering from an Achilles tendon injury, it is best to rest and follow your doctor’s advice. Continuing high-impact activities can worsen the injury and prolong your recovery time.

How long does it take to recover from Achilles tendinitis?

Mild cases of Achilles tendonitis may recover within 4–6 weeks, while chronic cases could take longer. Your doctor will better be able to guide you regarding realistic recovery times based on your condition.

Is surgery always required for an Achilles tendon rupture?

No, some cases of Achilles tendon injury may recover from non-surgical treatment options, whereas others may require surgery. Partial tendon tears can sometimes heal with immobilisation and physical therapy, but complete ruptures often need surgery.

What are the signs of an Achilles tendon rupture?

If you experience sudden, severe pain at the back of the ankle, difficulty walking, and a popping sound during the injury, chances are that your Achilles tendon may have ruptured. Contact your nearest healthcare provider to seek immediate medical care.

How can I prevent Achilles tendon injuries while running?

Warming up, stretching regularly, and wearing proper running shoes are some of the ways you can prevent Achilles tendon injuries. Moreover, avoid abrupt increases in distance or intensity.