What is it about ?
The Achilles tendon is sensitive to overwork. Joggers, for example, often suffer from Achilles tendon injuries. In severe forms of tendon disease (tendinopathy), partial or total tearing of the tendon is possible. Anyone who puts too much strain on the Achilles tendon may have symptoms related to an Achilles tendon injury. The use of a particular class of antibiotics (fluoroquinolones) or corticosteroids increases the risk of tendinopathy as well as tearing of the tendons.
Where do they occur?
A tear of the Achilles tendon typically occurs in men between the ages of 30 and 50, during athletic activity (for example, during a game of ball).
How to recognize them?
When we talk about tendinopathy, it is often an inflammation of the tendon and surrounding tissues.
On the other hand, in chronic forms, it is no longer an inflammation, but a loss of quality in the tissue of the tendon. In this case, you have the following symptoms:
- pain and swelling around the Achilles tendon;
- pain when contracting and extending (stretching) the calf muscles;
- local tenderness or pain on examination on both sides of the Achilles tendon;
- lump along the middle third of the tendon.
A torn or ruptured tendon causes sudden pain that quickly subsides. People with a ruptured tendon say it is as if someone kicked them from behind.
How is the diagnosis made?
The doctor will conclude that there may be a problem with the tendon based on your complaints and based on the physical examination. He will be attentive to the pain, the swelling and he will check the functioning of the Achilles tendon.
He will ask you to stand on your tiptoes. This allows him to see if you have a torn tendon. In the event of a torn tendon, it will be difficult or even impossible for you to stand on your tiptoes; the doctor may also feel a hollow at the site of the tear. The more time elapses between the tear and the examination performed by the doctor, the more complicated it is to feel the rupture of the tendon. This is because blood and fluid flow and cause the affected area to swell.
If in doubt about the diagnosis of a (partial) tear, an ultrasound may be useful to be more certain. You have to wait quite a long time before having an ultrasound, because the presence of fluid and blood in the area of the lesion complicates the examination. In addition, the examination is unreliable if it is performed too soon after the trauma.
In rare cases, a magnetic resonance imaging (MRI) exam may be ordered.
What can you do ?
Stop all sports activities that trigger symptoms. The alternatives for athletes who like jogging and long-distance running are aqua-jogging and swimming. Perform regular stretching exercises for the Achilles tendon and calf muscle. At home, regularly continue the medical gymnastics exercises that the physiotherapist will have explained to you. It is indeed important to “train” the tendon so that it can endure the stresses more in the long term.
What can your doctor do?
Non-drug therapy
The doctor and the physiotherapist will teach you so-called “eccentric” exercises for the tendon. These are exercises designed to train the calf muscles and the Achilles tendon. Correct and regular practice of these exercises is important. They are easy to perform at home on the edge of a staircase: from the starting position (standing on tiptoes), lower the heel of the affected foot, controlling the descent, to under the edge walk, then return to the starting position, transferring the weight to the unaffected foot.
The physiotherapist will help you in setting up a suitable exercise regimen. Well-adapted medical gymnastics lasts at least 3 months and consists of doing repeated exercises every day, for example 3 sets of 15 with the knees straight and 3 sets of 15 with the knees bent, 2 times a day.
A small heel pad in the shoe can help.
Medications
If certain specific symptoms are present, anti-inflammatory drugs (such as ibuprofen) may be indicated.
In competitive athletes with a serious problem with the Achilles tendon, the doctor may consider subcutaneous injections of low molecular weight heparin for 3 days. Since heparin therapy requires multiple visits and is associated with a slightly increased risk of bleeding, the doctor should carefully consider the pros and cons. Heparin cannot be combined with anti-inflammatory drugs, but with a pain reliever such as paracetamol.
Surgical intervention
The doctor may suggest an operation if none of the above treatments gives the expected results. The operation is especially indicated for young people or athletes suffering from a torn Achilles tendon. The risk of a new tear is lower (1 to 2%) after an operation than when one does not operate (10 to 15% risk of a new tear). It is very important to take quickly, within a week, the decision to operate (or not), and this to increase the chances of healing from a ruptured tendon.
Want to know more?
- Achilles tendon – Health Passport
- Tendonitis: rest and cold – mongeneraliste.be – SSMG – Scientific Society of General Medicine
- Tendonitis: think about medication – mongeneraliste.be – SSMG – Scientific Society of General Medicine
- Achilles tendinopathy. Exercises to do at home, on video – PodFormance – Clinique podiatrique
- Ultrasound here Where to find on this page of Cliniques St Luc UCL
- MRI, here, Where to find on this page of Cliniques St Luc UCL
- Paracetamol – CBIP – Belgian Center for Pharmacotherapeutic Information
- Ibuprofen – CBIP – Belgian Center for Pharmacotherapeutic Information
- Nonsteroidal anti-inflammatory drugs – CBIP – Belgian Center for Pharmacotherapeutic Information
- Corticosteroids – CBIP – Belgian Center for Pharmacotherapeutic Information
- Low molecular weight heparins – CBIP – Belgian Center for Pharmacotherapeutic Information
- Quinolones – CBIP – Belgian Center for Pharmacotherapeutic Information