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Achilles Tendonitis and Tendon Tears

The Achilles tendon is the largest and strongest tendon in the human body, and the most frequently torn. It connects the calf muscle to the heel bone. We use it when we walk, run, climb, jump, and stand on our tiptoes! Multiple factors contribute to tendon disease including exercise, overuse, genetic predisposition, and aging. In general, men are more likely than women to suffer an Achilles tendon disorder.

Achilles tendon disorders include tendinitis and rupture. Both are a frequent cause of pain and disability in athletes and non-athletes alike.

Achilles tendinitis (also called tendinopathy) is an overuse injury. It is not caused by any specific injury but rather by repetitive use that creates microscopic tears in the tendon tissue damaging the tendon. Achilles tendinitis is widespread among athletes who participate in running and jumping sports whether recreationally or professionally.

An acute rupture is a partial or complete tearing of the tendon. It typically occurs spontaneously but can also result from of a sudden force that stresses the calf muscle during a sport or a simple run or jump in healthy active people. Middle-aged people are most likely to experience an acute tear with a sudden force injury. In addition, the Achilles tendon that has been damaged by overuse increases the risk of a tendon rupture.

Achilles tendinitis is caused by repetitive stress on the feet from any sport that requires the foot and toes to push off, or a sudden increase in activity. About 52% of runners experience Achilles tendinitis. However, it is also a common injury in nonathletes (65% of cases are not related to athletics) and impacts the ability to perform the daily functions of life.

Risk factors include being male over age 30, a middle-aged woman, obesity, alcohol use, a history of steroid use, oral contraceptives, hormone replacement therapy, certain antibiotics, genetics, a sudden increase or intensity of exercise, poor conditioning, and tight calf muscles.

What are the symptoms of tendinitis?

Primary symptoms are pain and reduced function. Other symptoms include:

  • Soreness/tenderness
  • Morning stiffness
  • Swelling
  • Localized pain at the back of the heel or along the tendon 

What can cause an acute tendon tear?

  • Sudden forceful stress on the calf muscles from athletics
  • Running uphill
  • Running on a hard surface
  • Pushing off on the ball of the foot with force as seen in basketball, tennis, and football.
  • Sprinting that requires a quick start and stop
  • Falling off a ladder or height
  • Stepping into a hole

Men aged 25 – 45 are more likely to suffer an Achilles tendon rupture than women. High energy sports are responsible for acute tears in young men while low energy injuries, and degenerative tendons typically cause tears in people over the age of 60. Underlying medical conditions such as thyroid disease, rheumatoid arthritis, diabetes, and obesity increase the risk of rupture.  Other risk factors include poor conditioning, oral or injected steroids, use of some antibiotics.

A partial tear may cause no or only mild symptoms. A complete tear is painful and affects strength and movement. Other symptoms include:

  • A popping sound or sensation
  • A sudden, sharp pain in the heel/back of the ankle
  • A feeling that someone kicked your ankle
  • Limping, pain during running and jumping
  • Swelling and bruising and the inability to point the foot downward or stand on tiptoes.

It is diagnosed by history and physical exam. Ultrasound and MRI are useful to assist in diagnosis.

It is diagnosed by history and physical exam . Ultrasound and MRI are useful to assist in diagnosis.

Dr. Ajay C. Lall is a former dual sport NCAA collegiate athlete (football and track & field), American board certified, triple fellowship-trained expert orthopedic surgeon who specializes in diagnosing and treating knee injuries. He treats non-athletes and athletes at all levels of play from collegiate to professional to the Olympic level. Dr. Lall is a world-renowned orthopedic surgeon who cares for all patients like family. Contact LALL Orthopedics + to schedule a consultation, receive the correct diagnosis, and undergo state-of-the-art treatment options.

At a Glance

Ajay C. Lall, MD, MS, FAAOS

  • Board Certified – Orthopedic Surgery
  • Triple Fellowship Trained
  • Performs over 750 Surgeries Per Year
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