The Achilles tendon is the strongest tendon in the body but it is also the one that is most commonly injured. In this article we discuss the anatomy of the Achilles tendon as well as give an overview on common problems that can occur with the Achilles tendon.
The Achilles tendon is approximately 15 cm in length and is made up of a combination of fibers that are derived from two calf muscles: the gastrocnemius and soleus muscles. As the tendon descends, the fibers twist 90 degrees until it attaches into its insertion at the back of the calcaneus or heel bone. The Achilles tendon gets its blood supply from 3 sources. The muscle bellies (gastrocnemius and soleus) that they are attached to, the bone (calcaneus) that it inserts into, and a membrane that incases the tendon called the paratenon. There is an area on the tendon approximately 2 to 6 cm above its insertion to the calcaneus, that is a common area for Achilles tendon lesions and ruptures.
Four types of issues exist with the Achilles tendon. The most common is Achilles tendonitis. It means inflammation so tendonitis means inflammation of the associated tendon. Achilles tendonitis is usually due to overuse, lack of stregth or to much stress on the tendon. Commonly, tendonitis is treated with physical therapy, orthotic insoles and stretching.
If the tendonitis is not treated, the tendon begins to scar and get microscopic tears in the region. This is called tendinosis which means chronic scar formation and tear. Commonly, tendinosis takes months to years to develop and there is scarring and thickening of the tendon. There is also a lack of blood to the damaged region as the body finds that it cannot heal the area and stops functioning to try and heal the damaged region. The goal of Achilles tendinosis treatment is to increase blood supply to the damaged tendon and protect the tendon to allow the body to heal the area. This is performed with physical therapy, platelet rich plasma injection, stem cell injection or all of the above at times. Surgery is rare but may be needed in severe cases that do not respond.
Achilles tears are a common problem and mainly treated with surgical repair. Surgical repair of the Achilles has been very successful and has been shown to be better than casting. Strength is improved and recovery is often faster with surgery. Our goal with surgery is a strong repair and limited casting. Physical therapy is started very early to limit weakening of the muscle and tendon.
If the Achilles tear is not repaired right away the ends of the tendon may separate and a secondary repair at a delayed time may be necessary. This is done by stretching the Achilles and adding a tendon transfer to strengthen the repair.
If the Achilles is tight and pulls on the heel region for a chronic period of time bone spurs may form causing pain and swelling. This is partly due to mild tears of the Achilles and partly from the bone spurs. Conservative options include orthotic insoles with a small lift and physical therapy. If surgery is necessary, the Achilles is repaired and spurs are removed.
University Foot and Ankle Institute is proud to be a center of excellence in the treatment of Achilles tendon abnormalities. We specialize in the care of patients with both acute and chronic Achilles problems and are available to treat from the elite athlete to the weekend warrior.