Achilles Tendon Q & A

Question Time Regarding The Achilles Tendon

I was recently interviewed by a high school student for a project they were doing regarding the Achilles tendon. They asked some good questions, which I did my best to answer from my clinical experience. Some of the questions I thought may be of interest to others, so I have chosen to post a selection of my answers here as a short blog.
It should be noted that I am not directly quoting any research and the answers I give are based on my opinions which draw on around 20 years of experience as a physiotherapist. Also all questions are answered with regard to my current client base. Working in a Sydney CBD physio practice where the majority of patients attending are between the ages of 20-65 yr old. The practice case load therefore doesn’t include a significant number of pediatric or geriatric patients. Hence my answers exclude Sever’s disease, a fairly common Achilles tendon condition experienced in adolescence.

What are the most common injuries regarding the Achilles Tendon during normal daily activities?
Acute aggravation of tendinosis (flare ups of chronic degenerative tendon complaints).
Basically this is an acute aggravation of a chronic degenerating tendon (occurring most commonly in around the 35-55 year old age group).

What are the most common injuries regarding the Achilles Tendon during sport related activities?

• Inflammatory over load to the tendon/tendon sheath complex.
• Acute aggravation of tendinosis (degenerative tendon complaints).
• Partial tears to the tendon.
• These injuries may occur in the mid tendon or at the tendons insertion into the heel bone. Noting than complete tendon rupture is not uncommon but is however less common than the above injuries to the Achilles tendon.

What are the most serious injuries involving the Achilles Tendon that you have seen?
Complete tendon rupture. This is where the Achilles tendon “snaps in half”. This sort of injury typically occurs in an individuals forties and fifties. However I have also seen them occur with people in their late twenties.

Other than rest, are there any other ways of treating overuse injuries such as Achilles Tendonitis?

• Eccentric loading exercises have a fairly substantial research base behind them in being an effective management approach for mid tendon Achilles complaints. Eccentric loading exercises are also effective treatment approach with the treatment of some other chronic tendon injuries such as “tennis elbow”.
• At our practice we also use shockwave therapy (an medical electrotherapy device) successfully in managing both insertional and mid tendon Achilles tendon complaints.

During activities such as hiking could serious damage to the Achilles Tendon prevent someone from walking on that leg entirely?
Partial and full thickness tears as well as ruptures which are all common in 30-50 yr olds. Any such tear could substantially impact the individuals ability to go hiking or at least go hiking with out moderate to significant discomfort. And if you did tear your tendon when hiking, then YES this would make it very painful and difficult indeed to complete the hike and get out of the bush.

On average – how long can a complete rupture of the Achilles Tendon take to recover fully from?
Achilles tendon rupture are managed more aggressively these days compared with when I first started practicing as a physio. However I would still guide people that with both conservatively managed (non surgically) or surgically managed Achilles tendon ruptures, someone should still anticipate it taking a full year for true return to play (achieving their previous activity or sporting level).

Can other muscles, tendons or tissues get injured from overuse or damage to the Achilles Tendon?
Poor function of the Achilles may overload the other muscles that work in synergy with the Achilles as they try to contribute more to substitute for a failing Achilles.
Also, in an attempt to avoid loading or stretching the Achilles to reduce pain or compensate for stiffness or weakness it is possible that undesirable movements at the foot, ankle and knee may occur which could lead to pain or injury in these areas.

If minor problems regarding the Achilles Tendon are not treated and vigorous exercise is continued, how bad can it get?
Tendinopathy progression can move from inflammation, to minor degeneration to partial or full thickness tears and on to complete rupture. Tendon injury doesn’t necessarily cascade down this path but continued loading on an irritated or damaged tendon may cause small tears to become larger and lead to a longer overall recovery…

What effects do steroidal injections have on tendon injuries?
There is research to suggest that cortisone (steroid) injections into the tendon increase the risk of future tendon rupture. Typically as a rule I never suggest someone to have a cortisone injection into their Achilles tendon (or any other tendon for that matter) to manage pain. It is due to this increased risk of tendon rupture and also that most tendon complaints I see are generally not strongly inflammatory in nature and are frequently more degenerative/partial tears. Therefore reducing inflammation via the use of a cortisone injection is often not strongly indicated in my patient case load.

Disclaimer: Sydney Physio Clinic does not endorse any treatments, procedures, products mentioned. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific advice or assistance regarding Achilles Tendon Q & A should consult his or her orthopaedic surgeon, general practitioner, sports medicine specialist or physiotherapist.