Achilles Tendon Problems: Tendinopathy and Rupture

Achilles Tendinopathy

In this overuse condition, pain usually develops over weeks:

• Pain behind the heel or a few centimetres above the attachment
• Marked stiffness with the first steps in the morning
• Pain that increases at the start of activity, eases as you warm up and returns the following day
• Thickening of the tendon

Treatment centres on a progressive loading exercise programme: controlled calf loading, particularly while the muscle lengthens. The programme takes weeks, and symptoms return if it is stopped early. A heel raise, footwear adjustment and load management support it.

Corticosteroid injection into the Achilles tendon is generally avoided because it may reduce the tendon's resilience.

Achilles Tendon Rupture

Rupture most often occurs in people aged 30–50 who do not exercise regularly, during an activity involving sudden acceleration or change of direction:

• A sensation of being struck on the back of the heel; sometimes an audible snap
• Inability to push off or stand on tiptoe
• A palpable gap along the tendon
• Rapidly developing swelling and bruising

Being able to walk does not exclude a rupture; other muscles compensate, so many patients walk with a limp. For this reason a significant proportion of ruptures are missed at first presentation.

Treatment follows one of two paths: immobilisation in a cast or special boot with the foot pointed downward, brought gradually to neutral; or surgical repair of the torn ends. The choice depends on age, activity level and the characteristics of the rupture.