A total tear in the Achilles tendon can happen in any part of its length. It is a sudden, traumatic injury. When the tendon snaps, it leaves two broken ends which may stay close together or spring apart, leaving a visible dent. There may also be bruising.

Achilles Tendon Rupture

Rupture is very rare in children, uncommon in teenagers, and happens most often to people in early and later middle age.

What you Feel When you Have Achilles Tendon Rupture

You feel as if something has hit you hard in the back of the leg. If you try to walk, you stumble or fall over. Your foot feel floppy: you can draw the foot upwards into dorsiflexion, but while toes can still move downwards into flexion, you cannot point the foot down at the ankle. If you lie on your stomach, the foot falls to a right angle. If the gastrocnemius muscle is squeezed, the foot does not move as it normally would: this is a standard test for Achilles tendon rupture, and does not cause pain.

Causes for Achilles Tendon Rupture

Although the rupture can be caused by a direct blow to the back of the leg when the calf is under tension, more often it is intrinsic, with no obvious cause. It usually happens late in an exercise session or competition, and is associated with fatigue and circulatory problems rather than being cold or not warmed up properly. You may have had previous warning signs, such as tightness, cramping or involuntary twitching in the calf. You may have been stressed, overtired or suffering from an infection. The tendon may have been weakened by previous injury or injection, or overworked by compensating for a previous thigh or foot injury.

Treatment for Achilles Tendon Rupture

The foot must be supported immediately with bandaging or taping in the plantarflexed position, pointing down from the ankle. Avoid putting weight through it: hop using crutches. If you have to put the foot down, keep the leg away from your body turned out sideways, and try to keep your weight on the heel.

Seek specialist advice as quickly as possible. You have the choice of an operation or non-intervention. Surgery can be done through a scar as open surgery.

Non-intervention is a choice between either immobilisation in a plaster cast for several weeks, or support in a removable walking boot which allows weight-bearing, remedial therapies, exercises and alternative training to commence immediately. You should decide with your doctor which approach you want to use, and then follow all instructions to the letter.

Read more about Achilles Tendon Injury: Should I go for Surgery?.

Rehabilitation Phases

In all cases the foot is held pointing downwards in plantarflexion for the first phase, as the tendon has to be prevented from lengthening as it heals. If it is not in plaster, the leg can be taped to hold the position. Crutches are used as directed by the specialist. In the case of the walking boot they may not be needed for long, but should be used when exercises are done without boot on.

Rehabilitation starts with calf strengthening holding the Achilles tendon in a shortened position. Progression through the rehabilitation phases should generally be pain-free. However, sometimes following open surgery there is a moment when some movement causes a tearing sensation around the scar, almost as if the injury has happened again. This is usually due to adhesions round the scar breaking, and does not interfere with your progress to fitness. If in doubt, refer back to your doctor.

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The tendon can become sore, thickened and tender to touch at the back of the ankle or just above, on one or both legs. The condition is called Achilles tendinitis, meaning inflammation in the paratenon. It is an overuse problem which happens mainly to teenagers and adults, but can happen to very young children.

Achilles Tendinitis

What you Feel When you Have Achilles Tendon Injury

Symptoms may appear gradually or suddenly. vFirst thing in the morning there is stiffness in the tendon, which wears off as you move around. There is no pain at rest. The tendon might hurt if you go up and down on your toes barefoot, but in the early stages this pain eases with repetitions. Going up and down on your toes wearing shoes usually causes pain. In the later stages, the tendon hurts when you walk and when there is any kind of pressure against it, for instance if you sit with your ankles crossed.

What are the Causes for Achilles Tendon Injury

If you feel the pain when you wear certain shoes, but not barefoot, the cause is friction from the back of the shoe. Most sports shoes have raised backs, known as heel tabs, as do many normal shoes. It may look low, but if the tab is any higher than the level of the ankle it puts pressure on the Achilles tendon. Boots with stiff seams do the same. Once the problem starts, any shoes which touch the Achilles tendon make it worse.

Other causes or aggravating factors of this type of pain include overtraining; faulty foot mechanics, especially overpronation; pain referred from the hip; poor circulation caused by sitting too long in tight clothing or with your ankles crossed; and hormonal changes in females.

Treatment for Achilles tendon Injury

Any faulty shoes must be discarded or modified by cutting the heel tabs back to the right level. In some cases this solves the problem immediately.

Some specialists offer injections into the painful tendon: if you choose this option, make sure your specialist is an expert, otherwise there is a strong risk of tendon rupture a few weeks later. A more drastic option in chronic cases is surgery to strip the tendon clean of inflammatory material.

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The tendon can be strained or suffer a minor tear at its attachment to the calcaneus. Sometimes the bursa between the tendon and the upper part of the bone becomes inflamed. In a chronic problem, spurs may form on the calcaneus. A spur can become detached, forming a focal point of pain. Achilles insertion problems can occur at any age. In children it is often linked to Sever’s disease.

Achilles Tendinitis

What you Feel When you Have Achilles Tendon Insertion Strain

Pain usually comes on gradually, although it can happen suddenly. You feel pain on tiptoeing or running. The heel is tender when you press on it. In the early stages the pain may wear off when you are warmed up, but recurs later during your exercise. The tendon gradually tightens. There is little or no pain at rest unless there is direct pressure on the heel.

Causes for Achilles Tendon Insertion Strain

There is usually excessive strain on the calf in extreme ranges of movement, for instance when you run uphill as fast as you can. Shoes contribute if they have rough, uneven linings round the heel; if the heel counter is soft, tight or not the right shape for your foot; if the sole is hard; or if the heel has worn down unevenly.

Treatment for Achilles Tendon Insertion Strain

Check your shoes and discard any which chafe, if padding does not help. You may benefit from orthotics. Your doctor or specialist may offer you an injection.

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A harmless but painful bony enlargement on the outer posterior heel is called a Haglund’s deformity, named for the doctor who first described it. This condition is commonly referred to as a “pump bump”, because women’s pump-style shoes, with rigid heel counters, contribute to its symptoms. Given this common name, it isn’t surprising that Haglund’s deformity occurs most frequently in women who spend a lot of time wearing dressing shoes

Haglund's Deformity

What Causes Haglund’s Deformity?

Most people with Haglund’s deformity have inherited a foot structure with this bony enlargement present at birth. With pressure and rubbing on the heel over time, a bursa forms and becomes inflamed and painful (bursitis). High-arched feet, in particular, tend to supinate when walking (inward movement of the heel causing a person to walk on the outside of the heel), causing the back of the heel to rub repetitively against the shoe’s heel counter. A tight or shortened Achilles tendon also contributes to the condition by compressing another bursa (the retrocalcaneal bursa, which everybody has) against the heel bone.

Symptoms of Haglund’s Deformity

Symptoms of Haglund’s deformity include pain, redness, and swelling at the back of the heel. Often, a callus also develops over the affected area.

Treatment of Haglund’s Deformity

Treatment of Haglud’s deformity begins with

If the above conservative treatments are not helpful, you may want to consider surgery. The procedure usually involves removing both the prominent bony enlargement on the back of the heel bone and the inflamed bursa.

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