Achilles Injury

Symptoms include:

• Pain in the heel during/after movement or exercise  

• Morning pain and stiffness in the Achilles tendon

• Thickened or swollen Achilles tendon

• Difficulty raising heels off the ground during walking or running.

• Patients often report feeling a pop sensation during explosive movement (May feel like been shot or hit in the back of the leg)  

• Heel pressure pain while wearing shoes  

Pain vs tear – What's the difference?  

Achilles Pain

Tendinopathy

With sudden increases in activity or general overuse, the Achilles is put under greater strain which can cause a Tendinopathy, usually occurring Achilles insertion (back of the heel) and the middle portion (midpoint).  

What is tendinopathy?  

Healthy tendons are composed predominantly of type I collagen. These are arranged in a highly organized, parallel structure. This organization gives the tendon high tensile strength and elasticity, allowing efficient energy storage and release during explosive movements.

In tendinopathy, this remodeling process does not fully occur. Ongoing inflammation or poorly managed loading, and reduced tissue recovery time, repeatedly re-injures the tendon. As a result, the tendon remains in a constant cycle of repair, continuing to produce type III collagen instead of progressing to mature type I collagen. This causes pain, decrease in elasticity of the tendon and an overall decrease in athletic performance  

Could it be Achilles tendon bursitis

Bursitis?

Bursae are small fluid filled sac which help reduce friction between tendons, muscles, and bones, and are many throughout the body. At the back of the heel, there is a small bursa that cushions the movement between the tendon and heel. This bursa can become inflamed and irritated, often due to pressure from stiff or poorly fitting footwear or repetitive stress – This is known as bursitis

Tenosynovitis of Achilles tendon

Generally, through overuse, spikes in training loads, activities or sport, or through repetitive movements, we can also create inflammation of peritendon. The peritendon is sheath or casing surrounding the tendon. This can often feel like sand in the tendon, and you may hear some crackles moving the ankle through its range.    

Achilles Tears and Ruptures  

Achilles rupture

Achilles rupture generally occurs during explosive movements, such as jumping and pushing off with ankle. Most people describe pop sensation/feeling, often described as being hit on the back of the leg. Post injury patients will lose the ability to push off from their foot and may associated bruising and swelling  

Plantaris rupture

The plantaris is a small, thin muscle that runs along the medial (inside) side of the Achilles tendon. Rupture typically occurs during explosive movements, similar to those that cause Achilles tendon ruptures. Patients may experience sudden calf pain with bruising and swelling just medial to the Achilles tendon. These injuries are significantly less severe than an Achilles rupture and usually recover with conservative management.

Treatment and management options

Achilles pain

All different types of Achilles of pain and presentation require specific assessment and management. In early stages of rehab complete rest is not recommended, while we want to avoid aggravating factors and modify load. Tendons need progressive loading to stimulate collagen repair, improve tissue structure, and restore their strength and elasticity.  

Achilles Injury

Achilles of ruptures will require a review from an orthopedic foot and ankle surgeon. Specific surgery techniques will be dependent on the surgeon, which involves reattached by the Achilles, which if followed by a period of immobilization in a CAM boot.  

Heel pain in kids?

Heel pain in kids is very common and can often be related to a condition called Severs disease.

Severs disease?

Severs disease is a condition where due to rapid growth spurts or lots of sporting loads can create inflammation and irritation at the base of the heel. Repetitive stress from the Achilles tendon during rapid growth can irritate the growth plate at the heel, a condition known as apophysitis. The typical age range for servers is approximately 7-15 with a peak of 10 years.

As a parent, should I be worried?

Severs is not dangerous. With the right load management, footwear and advice, will help your child recover and minimise time spent on the side lines.  

Why getting the right advice is important  

We recommend seeking help from a Physiotherapist who will diagnose the type of Achilles pain or injury you may have, as each type of Achilles injury requires a specific type of management. Our physiotherapy team at TSIC will complete a comprehensive assessment, where you will be guided through a tailored rehabilitation program and post-surgical management if required.  

References:

Conservative Treatment of Sever’s Disease: A Systematic Review (2024)  

The load borne by the Achilles tendon during exercise: A systematic review of normative values (2023)

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