Anatomy

A tendon attaches muscles to the bone. Your Achilles tendon is the biggest and strongest tendon in the body. It is found at the back of the lower leg, just above the heel bone. It attaches your two calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus) and helps you go up onto tiptoes.

Injury

With aging and overuse, the Achilles tendon is subject to degeneration and weakening within the substance of the tendon. Over time, some of the individual strands of the tendon can fray, and other fibers break, causing the tendon to lose strength.

The tendon becomes thickened because of the formation of scar tissue. This condition is known as tendonitis or tendinosis.

When the Achilles tendon ruptures, the person hears a “pop” at the back of the lower leg. There is sudden pain in the region of the Achilles tendon.

Treatment

The treatment has two objectives:

1. To reduce the inflammation.

2. To allow the tendon to heal.

Ice the Achilles tendon for minutes, two or three times a day, and after any sporting activities. Apply a bag of crushed ice over a towel or submerge the foot of the tendon in a pan of ice water. This reduces swelling, inflammation, and pain.

A physiotherapist or doctor can recommend exercises to strengthen the muscles. Exercises can also be used to stretch and balance the calf and leg muscles. In some cases, surgery may be indicated.

Rehabilitation Strategies:

• Gradual Loading Program: Implement a phased Achilles tendon loading program that increases the load on the tendon and calf muscles over a period of about six months. This should include running and jumping activities, but these should be monitored using a pain-monitoring model.

• Eccentric Exercise: Incorporate eccentric exercise, particularly for non-acute cases. This can include exercises like heel drops off the edge of a step. However, it is important to note that eccentric exercise may be less effective for sedentary people compared to athletes.

• Improve Strength and Range of Motion (ROM): After the initial immobilization period (if required), focus on improving the ankle range of motion through gentle passive mobilization and active exercises. Progressively add resistance exercises to increase muscle strength and coordination.

• Foot Core Strengthening: Include exercises to strengthen the foot core muscles, which are crucial for stabilizing the foot and engaging the calf muscles effectively. This involves balancing the work of the tibialis posterior with the tibialis and peroneus muscles.

• Gait Training and Functional Rehabilitation: Progress to functional exercises like single-leg stance and heel raises. This phase focuses on returning to sport-specific activities, typically starting 4-6 months into therapy, depending on individual progress.