Dr. Goldberger: Hi. It's Michael Goldberger. I'm one of the foot, ankle specialists at Tri-County Orthopedics.
The Achilles tendon is a fibrous cord which connect the muscles of the calf to the heel bone. It's used every time you take a step to push off. Common injuries associated with the Achilles tendon are Achilles tendonitis, which means inflammation around the Achilles tendon. You could have micro-tears or partial tears of the Achilles tendon. In addition, the most extreme example is a rupture of the tendon itself.
Common symptoms of Achilles tendon injuries, first of all, is pain on the back of your Achilles tendon. Two, many times when a patient stands up they'll feel stiffness into the morning, or when they first start walking on it. They may notice worsening pain as they continue to exercise.
Many factors can contribute and trigger an Achilles tendon injury. Most commonly, a rapid increase of speed or mileage can contribute to an Achilles tendon injury. If suddenly you add stairs for hill climbing, plus maybe a natural predisposition for muscle tightness and starts running quickly can cause an Achilles tendon injury. Lastly, if you're wearing a worn out pair of sneakers, that can also contribute to this.
You should see a specialist for an Achilles tendon injury if you're still having pain in the Achilles tendon area after two or three weeks of rest. In addition, if you have a sudden sharp pain or hear a pop, have difficulty walking, you should immediately consult a doctor.
Nonoperative treatment for Achilles tendon injury is the main step. First of all, rest from the activity which is causing the problem. So if you are a runner and also you decide to stop swimming or biking, that's appropriate. Two, you could add a heel lift or orthotic into your shoe to take some of the tension off the Achilles tendon. Three, a stretching program by yourself or with a physical therapist. Next you could take some anti-inflammatory medicine, and that also will be effective.
The surgery for Achilles tendonitis is typically the treatment of last resort. Many times, the sheath around the tendon becomes thickened and fibrous. Surgery essentially releases that sheath and repairs any micro-tears. When a patient has a rupture, especially in someone who's very active, surgical repair is typically preferable to nonoperative treatment. Lastly, if you have a chronic tear, many times you need to have a new tendon replaced, called a tendon transfer.
With modern surgical techniques, we expect a full recovery with Achilles tendon injuries. Typically, when repairing Achilles tendonitis and we release the sheathing and repair micro-tears. After short courses of mobilization you place them in a cam walker or rocking boot, get them started on therapy immediately.
When someone has Achilles tendon repair or rupture, typically use a two to three-week course of elevation non weight-bearing and then weight-bearing, either in a cast or walking boot with aggressive physical therapy thereafter. Within six to nine months, we expect a full recovery.