The Achilles tendon is important for almost every movement involving your lower body, from walking and running to jumping and climbing stairs. Because it endures such constant strain, it’s also one of the most commonly injured tendons in the body. Whether you’re an athlete, a weekend runner, or simply leading an active lifestyle, understanding Achilles tendon injuries and how to treat and prevent them is essential for maintaining long-term mobility and strength.
Understanding the Achilles Tendon
The Achilles tendon connects the heel to the calf. You use it to walk, run, and jump, so it’s constantly under pressure. Over time, this pressure can cause the tendon to become irritated or tear.
A tear in the Achilles tendon (also known as a rupture or snap) is one of the most common Achilles injuries, occurring in about 18 of every 100,000 patients. It typically occurs in men over 30 and continues to increase in patients aged 40–59 for two main reasons:
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Muscles and tendons stiffen with age, making them more likely to snap when stretched.
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Patients in this age group tend to be “weekend warriors”: people who may not exercise as much during the week and then take part in recreational activities on weekends.
Before moving forward with treatment for any type of Achilles tendon injury, it’s important to understand why the injury occurred and how different treatment options and behavioural changes can prevent it from happening again.
Identifying Achilles Tendon Injuries
Achilles tendon injuries are categorized as acute or chronic.
Acute injuries include:
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Rupture: The result of overuse and the lack of a proper warm-up before exercise. It often occurs during sports such as soccer, basketball, volleyball, and softball. When a patient pushes their foot off the ground, they feel a snap as if someone stepped on or threw a ball at the back of their leg.
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Tendonitis: Inflammation that occurs when patients ramp up their exercise too quickly. It can cause ongoing pain and swelling in the heel, ankle, and back of the leg.
Chronic injuries include:
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Haglund’s deformity: A painful bump that forms on the back of the heel and rubs against the Achilles tendon.
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Heel spur: A calcium buildup on the back of the heel that can cause the Achilles tendon to become more inflamed.
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Tendinosis: Tendon damage that occurs when tendonitis is not treated. It causes the Achilles tendon to become hard and rubbery.
To diagnose your injury, your doctor or physiotherapist will examine your foot and ankle, ask you to demonstrate your range of motion, and perform imaging tests to look for damage.
Achilles Tendonitis
Achilles tendonitis is an overuse injury of the Achilles tendon, where the band of tissue connecting calf muscles to the heel becomes inflamed. Achilles tendon pain can be sudden or ongoing, often described as a throbbing, burning sensation that won’t go away.
During the initial assessment, your physiotherapist will identify the location of your pain and address swelling in the leg and ankle region. They may also ask about movements that make it worse, such as climbing stairs, walking, running, or standing on your toes.
Ice and massage therapy can help relieve swelling and loosen surrounding muscle tissue.
Achilles Tendonitis Treatment
Rest and Ice
The initial step in treating Achilles tendonitis is to rest and follow the R.I.C.E. protocol (Rest, Ice, Compression, Elevation). Ice can help reduce swelling and alleviate pain when applied to the affected area.
Physiotherapy and Exercise
Physiotherapy plays a crucial role in recovery. Under the guidance of your therapist, you will take on strengthening, flexibility, and gait dynamics work.
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Stretching and Flexibility Exercises: These are key to helping the tendon heal without shortening and causing long-term pain.
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Strengthening Exercises: They help you regain strength lost while the tendon was healing and protect you from further injury.
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Eccentric Exercises: Involving lengthening the muscle while it contracts, these are often prescribed for tendon remodelling and strengthening.
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Deep Massage: Helps increase flexibility and blood circulation in the lower leg.
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Ultrasound and Heat Therapy: Improves blood flow and may aid the healing process.
Exercise with your physiotherapist or in a rehab program will help your lower leg and ankle regain strength and flexibility. Although treatment for Achilles tendon problems takes time, it usually works, and most people can return to sports and daily activities.
Minimally Invasive Surgery for Achilles Rupture
Ruptures are often treated surgically in patients who are healthy and want to return to their former level of activity. Some studies show that surgical treatment can reduce the risk of re-rupture compared to nonsurgical care.
Minimally invasive repair allows the patient to start weight bearing sooner than traditional surgery, leading to faster recovery. Smaller incisions mean easier wound care, lower risk of scarring or infection, and shorter recovery.
Patients leave the hospital with a cast or boot the same day. After a week, a physiotherapist will examine pain levels and guide a basic exercise program.
Alternative and Nonsurgical Treatments
Nonsurgical treatment is recommended for older or less active patients. It usually involves a cast or boot for four to 12 weeks, depending on severity. Ice and pain medication can be used as needed.
Once weight bearing is possible, physiotherapy begins to strengthen and stretch the tendon and surrounding muscles. In severe chronic injuries, surgery may be an option to:
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Transfer another tendon to assist with push-off.
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Remove damaged tendon tissue.
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Lengthen the tendon to reduce strain.
Advanced and Emerging Treatments
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Orthotics and Supportive Footwear: Proper footwear and inserts reduce strain and help alignment.
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Medication: NSAIDs such as ibuprofen can manage pain and inflammation.
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Shockwave Therapy: Uses acoustic waves to stimulate blood flow and healing.
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Platelet-Rich Plasma (PRP) Therapy: Involves injecting a concentrated solution of your blood platelets to promote tissue repair and regeneration.
Surgery is considered a last resort when conservative treatments fail.
Recovery and Rehabilitation
Full recovery from an Achilles injury usually takes six to twelve months. The timeline depends on the injury type, treatment method, and personal fitness goals.
Early physiotherapy emphasizes pain management, rest, and gradual reintroduction of activity. As symptoms improve, focus shifts to flexibility, strength, and movement patterns.
Prevention Tips
Taking precautions can reduce your risk of Achilles injury:
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Warm up for at least five to ten minutes with a walk or dynamic stretches.
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Wear athletic shoes that fit properly.
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Increase workout intensity gradually, no more than 10% weekly.
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Vary your workouts to avoid repetitive strain.
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Stretch after exercising, especially your calves.
Achilles tendon injuries, from mild tendonitis to full ruptures, require timely care and structured rehabilitation. With physiotherapy, appropriate rest, and gradual strengthening, most patients regain full mobility and return to activity.
