Achilles Tendon Injuries (Tendinopathy)

Front 1

Grade 1

Back 1

Mild strain, disruption of a few fibers. Mild to moderate pain, tenderness, swelling, stiffness. Expected to heal normally with conservative management.

Front 2

Grade 2

Back 2

Moderate strain, disruption of several fibers. Moderate pain, swelling, difficulty walking normally. Expected to heal normally with conservative management.

Front 3

Grade 3

Back 3

Complete rupture, often characterized by a "pop," immediate pain, inability to bear weight. Typically requires surgery to repair.

Front 4

How does it occur

Back 4

Most often, Achilles tendon pain is the result of repetitive trauma to the tendon. This repetitive strain can result in chronic Achilles tendinopathy, which is a gradual breakdown of the tissue and is most often treated with physical therapy.Ankle stiffness
Calf tightness
Calf weakness
Abnormal foot structure
Abnormal foot mechanics
Improper footwear
A change in an exercise routine or sport activity

Front 5

How does it feel

Back 5

Tenderness in the heel or higher up in the Achilles tendon
Tightness in the ankle
Tightness in the calf
Swelling in the back of the ankle
Pain in the back of the heel
Pain and stiffness with walking, worst with the first several steps

Front 6

How is it treated (Diagnosed)

Back 6

Your physical therapist will review your medical history and complete a thorough examination of your heel. The goals of the initial examination are to assess the degree of the injury and determine the cause and contributing factors to your injury.

It is common for your physical therapist to perform a movement assessment. This may include watching you walk, squat, step onto a stair, or balance on 1 leg. The motion and strength in your leg will also be assessed.

Your physical therapist may also ask questions regarding your daily activities, exercise regimens, and footwear to identify other contributing factors.

Imaging techniques, such as x-ray or MRI, are often not needed to diagnose Achilles tendinopathy

Front 7

Pain

Back 7

Many pain-relief strategies may be implemented, such as applying ice to the area, putting the affected leg in a brace, or using therapies such as iontophoresis (a medicated patch placed on the skin that is electrically charged and used to decrease pain and inflammation) or therapeutic ultrasound.

Front 8

Range of Motion

Back 8

Your ankle, foot, or knee joint may be moving improperly, causing increased strain on the Achilles tendon. Self-stretching and manual therapy techniques (massage and movement) applied to the lower body to help restore and normalize motion in the foot, ankle, knee, and hip can decrease this tension.

Front 9

Muscular Strength

Back 9

Muscular weaknesses or imbalances can result in excessive strain on the Achilles tendon. Based on your specific condition, your physical therapist will design an individualized, progressive, lower-extremity resistance program for you. You may begin by performing strengthening exercises in a seated position -- for example, pushing and pulling on a resistive band with your foot. You then may advance to exercises in a standing position -- for example, standing heel raises.

Front 10

Manual Therapy

Back 10

Your therapist may treat your condition by applying hands-on treatments to move your muscles and joints in order to improve their motion and strength. These techniques often address areas that are difficult to treat on your own.

Front 11

Functional Training

Back 11

Once your pain, strength, and motion improve, you will need to safely transition back into more demanding activities. To minimize the tension on the Achilles tendon and your risk of repeated injury, it is important to teach your body safe, controlled movements. Based on your goals and movement assessment, your physical therapist will create a series of activities that will help you learn how to use and move your body correctly to safely perform the tasks required to achieve your goals.

Front 12

Patient education

Back 12

Your therapist will work with you to identify, and establish plans to address, any possible external factors causing your pain, such as faulty footwear or inappropriate exercises. He or she will assess your footwear and recommend improvements, and develop a personal exercise program to help ensure a pain-free return to your desired activities.

Front 13

Info

Back 13

Physical therapy promotes recovery from Achilles tendon injuries by addressing issues such as pain or swelling of the affected area, and any lack of strength, flexibility, or body control. When the condition remains untreated, pain will persist and may result in a complete tear of the Achilles tendon, which often requires surgery to repair.

Front 14

Info

Back 14

If your surgeon decides that surgery is needed, physical therapy will be necessary after surgery for several months. Immediately after surgery, your ankle will be placed in a splint or cast with crutches to allow the repaired tissue to heal. Once sufficient healing has occurred, you will work with your physical therapist to progressively regain your ankle mobility and leg strength. He or she will also help you regain your ability to walk without assistance—and carefully guide your return over time to your desired recreational activities

Front 15

Prevented

Back 15

Maintaining appropriate lower extremity mobility and muscular strength, and paying particular attention to your exercise routine—especially changes in an exercise surface, the volume of exercises performed, or your footwear are the best methods for preventing Achilles injuries