This tendon is named after Achilles, who according to myth was protected from wounds by being dipped in a magical pond by his mother. She held him by the heel, which was not immersed, and later he died by an arrow wound to his heel.
The achilles tendon is the connection between the heel and the most powerful muscle group in the body. This has long been known as a site prone to disabling injury. Forces up to 12 times body weight may arise during sporting activity.
The achilles tendon joins three muscles: the two heads of the gastrocnemius and the soleus. The gastrocnemius heads arise from the posterior portions of the femoral condyles (back of the thigh bone). The soleus arises from the posterior aspect of the tibia and fibula (the two bones in the lower leg).
The gastrocnemius is a muscle that crosses three joints: the knee, the ankle, and the sub-talar joint (major joint in the foot). The functioning of these joints and influence of other muscles on these joints has a significant effect on the tension that occurs within the achilles tendon. As an example tight hamstrings impact the functioning of the ankle joint, the sub-talar joint, and increase tension in the achilles tendon. The soleus muscle does not cross the knee and is a bi-articular muscle (affects the movement of two joints).
The bulk of the achilles tendon inserts into the upper back third of the calcaneus (heel bone). Some fibres run further down and insert into the bottom of the heel bone.
Achilles tendinitis develops due to inflammation, strain, or repetitive trauma to the achilles tendon. This occurs usually due to a repetitive activity. Symptoms are also associated with recreational activities like running, tennis and basketball.
If this is left untreated, it can develop into achilles tendinosis, due to a degenerative change in the tendon from repetitive micro-trauma. The tendon scars and the inury becomes chronic in nature.
The majority of achilles tendon overuse injuries occur in middle aged, athletic males .Athletes with overly pronated feet may be at greater risk for developing achilles tendinosis. The increased pronation may put additional stress on the tendon, therefore, placing it at greater risk for injury.
Athletes with a rigid foot type also run a greater risk of all posterior group strains including Achilles tendinitis. A rigid foot type results in early heel lift during the contact phase of gait meaning that the athlete is "on their toes" earlier than is mechanically efficient causing the muscles and tendons in the back of the leg to work harder.
Events that can cause Achilles tendinitis may include:
Poor biomechanics
Hill running or stair climbing.
Overuse resulting from the natural lack of flexibility in the calf muscles.
Rapidly increasing mileage or speed.
Starting up too quickly after a layoff.
Trauma caused by sudden and/or hard contraction of the calf muscles when putting out extra effort such as in a final sprint.
Tight muscle groups in the back of the leg
Achilles tendinitis often begins with mild pain after exercise or running that gradually worsens. Other symptoms include:
Recurring localised pain, sometimes severe, along the tendon during or a few hours after running.
Morning tenderness about an inch and a half above the point where the Achilles tendon is attached to the heel bone.
Sluggishness in your leg.
Mild or severe swelling.
Stiffness that generally diminishes as the tendon warms up with use.
P - R - I - C - E
Protection - Your ankle may be splinted, taped or braced to prevent further injury. |
Rest - You should rest from all activities that cause pain or limping. Use crutches/cane until you can walk without pain or limping. |
 | Ice - Place a plastic bag with ice on the Achilles for 15-20 minutes, 3-5 times a day for the first 24-72 hours. Leave the ice off at least 1 1/2 hours between applications. |
 | Compression - Wrap an elastic bandage from the toes to mid calf, using even pressure. Wear this until swelling decreases. Loosen the wrap if your toes start to turn blue or feel cold. |
| Elevate - Make sure to elevate the ankle above heart level (hip level is acceptable during class). |
IF SYMPTOMS PERSISTS OR NUMBNESS/ DISCOLOURATION OF THE FOOT OCCURS CONSULT A MEDICAL PROFESSIONAL IMMEDIATELY.
TO RESTORE NORMAL FUNCTION |
As we get older the risk of Achilles tendon rupture goes up dramatically especially if we embark on high impact sporting activities. However it must be emphasised that the risk is still small but when recovering after any injury it is vital that when stretching or performing any exercise that there should be no pain. If any tenderness is elicited then stop and re commence P.R.I.C.E
| Technique: | Sit with your knee straight and hold the foot position as long as possible. Do as frequently as possible for the first 3-10 days. |
 | Pullback- Flex your foot back toward your body.
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| Technique: | Hold each exercise 30seconds at a gentle stretch. Do not bounce! |
| Frequency: | 6-10 repetitions/exercise, 5-7 days per week |
| Begin stretching regimen for gastrocnemius and soleus complex. Warning: There should be no pain when doing this exercise. If there is stop! |   |
| Technique: | Hold each exercise 30seconds at a gentle stretch. Do not bounce! |
| Frequency: | 3 sets 10 repetitions/exercise, 5-7 days per week progressing to 3 sets of 15 |
| Begin eccentric exercise program 7-10 days after pain has subsided
Start with toes pointed, giving resistance through the thera-band, slowly allow your foot into dorsiflexion. Warning: There should be no pain when doing this exercise. If there is stop! |   |
| Technique: | Hold each exercise 20seconds at a gentle stretch. Do not bounce! |
| Frequency: | 6-10 repetitions/exercise, 5-7 days per week |
| Perform a toe raise on a 4-6 inch box or step with both legs. Once on your toes, lift the uninvolved leg and lower yourself slowly into dorsiflexion (heel down, toe up).
Warning: There should be no pain when doing this exercise. If there is stop! |   |
| Technique: | Hold each exercise 30 seconds at a gentle stretch. Do not bounce! |
| Frequency: | 3 repetitions/exercise, 5-7 days per week, and incorporate into warm up and cool down exercises. |
| Perform a toe raise on a 4-6 inch box or step with both legs. Once on your toes, lift the one leg and lower yourself slowly into dorsiflexion (heel down) with the other. Repeat on the other side Warning: There should be no pain when doing this exercise. If there is stop!
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TO HELP PREVENT RE-INJURY |
RETURNING TO SPORTING ACTIVITY |
The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity is determined by how soon your achilles recovers, not by how many days or weeks it has been since your injury occurred.
You may safely return to your sport or activity when, starting from the top of the list and progressing to the end, each of the following is true:
You have full range of motion in the injured leg compared to the uninjured leg.
You have full strength of the injured leg compared to the uninjured leg.
You can jog straight ahead without pain or limping.
You can sprint straight ahead without pain or limping.
You can do 45-degree cuts, first at half-speed, then at full-speed.
You can do 20-yard figures-of-eight, first at half-speed, then at full-speed.
You can do 90-degree cuts, first at half-speed, then at full-speed.
You can do 10-yard figures-of-eight, first at half-speed, then at full-speed.
You can jump on both legs without pain and you can jump on the injured leg without pain.
disclaimer please read
Remember that virtually all achilles tendon problems occur at contact phase of gait (when the foot hits the ground) due to increased biomechanical stress at this point. No amount of exercising will influence what happens at the point of heel strike, mid-stance and toe off phases of gait. It is therefore vital to improve your biomechanics with orthotics designed for your chosen sport.