What is the Achilles Tendon?

The Achilles tendon is the largest tendon in the body. It is a powerful tendon extending from the calf muscles to the back of the heel. It provides immense power in push off while walking and running. In recent years we have discovered that through proper eccentric exercises the Achilles tendon can be strengthened in both tensile strength and in tissue mass. Up until this physiologic discovery was made, we often thought that the “Achilles heel” (Achilles tendon) was one of the limiting factors to athletic performance. Rupture of the Achilles tendon has sidelined many athletes over the years and has often been career ending, as these athletes are unable to regain full strength.

What is Achilles Tendonitis?

Acute inflammation of a tendon is called tendonitis. Tendonitis occurs from overuse in sports, excessively tight gastrocnemius and soleus muscles (calf muscles), poorly fitting shoes and improper biomechanical function as well as mechanical deformities. Swelling and abnormal popping of the tendon (crepitus) with or without nodular scar tissue formation is common in this condition. Left in a chronically inflamed state the tendon can develop tendinosis and begin to weaken and degenerate eventually leading to rupture. Carefully designed physician and therapist guided strengthening exercises along with improved mechanics can assist in providing an excellent outcome to this nagging disease.

What is Achilles Tendinosis? 

As noted above, tendinosis develops from chronic tendinitis which has not been cared for properly. A condition called liquefaction necrosis can develop within the Achilles tendon leading to significant weakness and eventually to Achilles rupture when treated improperly. The classification of tendinosis is usually made after 3 months of chronic tendinitis and is clinically diagnosed by physical exam and through the use of MRI studies to determine the extent of damage.

Achilles Tendonitis and Tendinosis Treatment 

Achilles tendonitis may often resolve with conservative care. Proper and complete collagen tendon tissue repair may take weeks to months depending on the severity, chronicity and care provided. High level studies have shown that the tendon tissues respond to eccentric exercises and very mild/ gentle stretching. It is not unusual for overstretching to exacerbate this condition. Physical therapy using ASTYM by a therapist properly trained and credentialed in this discipline is key to a timely recovery and in assisting the collagen fibers to return to normal. Proper biomechanical exam and correction of any mechanical deformity, shoe examination and a thorough evaluation of historical training errors are key factors in the long term care of this condition. In our high-end high school and collegiate athletes we place them on a sophisticated cross training exercise program to maintain mechanical and aerobic strength during their rehabilitation process.

Personal Experience 

During my competitive collegiate running years at Brigham Young University, Achilles tendonitis was my nemesis and required a redshirt year to fully recover. I have learned many things about running and Achilles tendon health through personal experience in the training room, sports journals and from making this condition a priority in my practice at The Foot and Ankle Institute of Utah. I look forward to assisting my patients to a speedy recovery and in returning to their sport and lifestyle.