Achilles tendon problems

What can go wrong with the Achilles?

Achilles tendinitis and tendinopathy

This is irritation and wear in the tendon, often from overuse, tight calves, or a sudden jump in activity. Doctors often say tendinopathy because the problem is usually wear and tear more than swelling. It comes in two main types:

• Midportion: pain and thickening a few inches above the heel
• Insertional: pain where the tendon attaches to the back of the heel bone

Haglund's deformity ("pump bump")

This is a bony bump on the back of the heel. Shoes with a stiff back can rub on it. It can irritate the tendon and the small fluid sac (bursa) nearby. It often goes along with insertional tendon pain.

Achilles rupture

This is a tear of the tendon, either part of the way or all the way through. It often happens with a sudden push-off, jump, or misstep.

Signs to watch for

• Pain and stiffness in the back of the heel or leg, often worse in the morning
• Pain that gets worse with walking uphill, stairs, or running
• A thick or tender spot on the tendon
• A bump on the back of the heel that rubs in shoes
• A sudden pop or snap, then trouble pushing off or standing on your toes

Treatment without surgery

Most tendon pain gets better without surgery, though it often takes time. Options include:

• Rest from activities that make it worse, without stopping all movement
• Heel lifts in your shoes to ease strain on the tendon
• Calf stretching and a guided strengthening program
• Physical therapy
• Shoe changes, such as a soft or open back for a pump bump
• A walking boot for a short time when pain is severe

Some Achilles ruptures can also be treated without surgery, using a boot with the foot pointed down and a careful therapy plan. The right choice depends on your health, activity level, and the tear.

When surgery helps

• Rupture repair: sewing the torn ends of the tendon back together.
• Haglund's and insertional surgery: removing the bony bump, cleaning out damaged tendon, and reattaching the tendon to the heel bone with anchors when needed.
• Long-lasting tendon pain: surgery may be considered when pain continues after several months of good non-surgical care.

Recovery

After surgery, you will usually spend time in a splint or boot, then slowly put more weight on the foot. Physical therapy is a key part of recovery. Walking in regular shoes often takes a few months. Getting back to sports often takes longer, sometimes 6 months to a year. Your time frame depends on the problem, the surgery, and your healing.

How Dr. Nafal can help

Dr. Nafal is board qualified in Foot Surgery and in Reconstructive Rearfoot and Ankle Surgery, and his focus includes reconstructive rearfoot and ankle surgery and lower extremity trauma. He explains every option in plain words, including options that don't involve surgery.

Common questions

Should I keep exercising with Achilles pain?

Many people can stay active with changes, like swapping running for biking. Pushing through sharp pain can make things worse. An exam can help you find a safe plan.

Can a steroid shot help my Achilles?

Shots right into the Achilles tendon are usually avoided because they may weaken it. Other treatments are often tried first.

Do all ruptures need surgery?

No. Some are treated in a boot with therapy. Dr. Nafal will go over the pros and cons of each choice with you.