You sprint and all of a sudden you feel a sharp pain at the back of your heel. Maybe you felt a tight pull in your calf or even heard a popping sound. You’re really not sure if you have strained your Achilles tendon or if you have torn it completely, but you are sure of your pain. With every step you take, you have sharp, pulling heel pain and it has literally stopped you in your tracks. This article will help you to understand the difference between a partial Achilles tendon tear and a complete Achilles tendon rupture and what you can do about it.

Even though Achilles tendon tears are a common injury among people who practice sport, it can just as easily happen to someone that’s not so active. It’s caused by overuse or overburdening of the Achilles tendon. Your Achilles tendon is the anchor that attaches your calf muscles to your heel bone and this makes it possible for you to point your foot. Lots of basic activities like walking, running or climbing stairs will be affected if you have a torn Achilles tendon.

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Anatomy of your Achilles tendon

A tendon is a band of tough connective tissue anchoring a muscle to a bone. Tendons can be compared to ligaments. Both are made of collagen, but ligaments connect bones to each other, whereas tendons connect muscle to bone.
The Achilles tendon is the biggest and strongest tendon in the human body and it anchors your calf muscles to your heel bone (calcaneus).

Connecting muscles to bone

Your Achilles tendon stems from your calf muscles and anchors them to the back of your calcaneus (heel bone). There are two main calf muscles called the gastrocnemius and soleus muscles. They join together and form the Achilles tendon, which in turn attaches to your heel bone (calcaneus).

The tendon and everything around it.

Healthy tendons are brilliant white in color and have a fibro-elastic structure that consists mostly out of collagen fibres. This gives the Achilles tendon the ability to be flexible, yet very strong.

There is a sheath (synovium) around the Achilles tendon that protects it and allows it to move freely between the layers of other tissue that surrounds it. Between the calcaneus and the tendon there is a bursa called the retrocalcaneal bursa. This bursa is a small fluid-filled sac that helps to decrease friction between the Achilles tendon and calcaneus. When these are injured it causes a specific pattern of ankle pain.

Fun Fact

The Achilles tendon is named after the great Greek hero, Achilles, who was dipped in the river Styx by his mother, for protection. He thus became invincible, except for the area around his heel, where his mother held him. This weak spot later caused his death when he was shot by an arrow through his heel. He couldn’t move after that and fought to his death. This gives meaning to the proverbial “Achilles’ heel”, meaning that it is your weak spot.

Achilles Tendon Tear, Torn Achilles tendon
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What does the achilles tendon do?

The Achilles tendon connects and anchors your calf muscles to your heel bone. So when your calf muscles contract, they pull on the Achilles tendon, which in turn then pulls on your heel bone (calcaneus).

Direction of movement

Concentric contraction: This happens when the calf muscles and Achilles tendon contracts together and shortens. It pulls on the heel bone and allows you to point your toes (plantarflexion). An example is when you stand on your toes to reach onto the top shelf or doing heel raises at the gym.
Eccentric contraction: This happens when the calf muscles and Achilles tendon is lengthening (or stretched) under load. Like when you pull your foot and your toes up towards you (dorsiflexion). An example of this is when you let your heel hang over the edge of a step or when you land back on the ground after jumping.

Your Achilles tendon is essential for all ankle movements.

It is specifically active in pushing off movements or controlling your landing onto surfaces. Like a strong bungee cord it is able to shorten and lengthen(recoil) together with your calf muscles.

  • Pushing off: This is a forceful pushing movement of your foot when your Achilles tendon shortens. Examples of pushing off includes pushing your heel off the ground when you’re standing on your toes, walking, running, jumping or pushing yourself away at the start of a sprint.
  • Controlling your landing: If your Achilles tendon can handle the force of pushing your heel up, it should also be able to absorb the force of your foot coming back down again. Now, it will need to lengthen with enough control. Like landing back on the ground after you’ve jumped up in the air. Your Achilles tendon needs to work the same way as a bungee cord that can be stretched all the way.

Without your Achilles tendon, your foot will simply feel floppy. You won’t be able to do some of the most basic ankle movements, never mind walk or run.

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I think I have an Achilles tendon tear. How did it happen?

The process of tendon injury

The collagen structure of tendons is made to be strong but elastic. However, because tendons consist mostly of collagen, they have poor blood supply. If you compare tendons to muscles, the blood supply of tendons (and ligaments) is 7.5 times lower than that of muscles. This means that tendons heal a lot slower after an injury due to low circulation of the necessary oxygen and nutrients.

The structure of a tendon will change if repetitive strain is put on it. The network of collagen fibers in a tendon gets disrupted by micro-trauma caused by too much strain (compression or tension). It leads to inflammation and increased cellular activity in the tendon, and this leads to more collagen cells getting produced. So, in an attempt to heal, your body produces more new collagen cells. However, this leads to the tendon thickening and becoming less flexible. Ultimately the collagen structure weakens.

Let’s talk about Achilles tendon pain and injuries specifically

Straining your Achilles tendon during physical exercise causes micro-trauma (injury) and inflammation. This happens when you overwork it above its physiological limit. Like running a race faster than what you prepared for. Ultimately this leads to micro-tears in the tendon structure and less flexibility, which limits the ability of the tendon to do the work that you want it to do.

Now, imagine a bungee cord with no elasticity. When the person at the end of the rope falls, the lack of elasticity means the rope won’t recoil. This means that the cord might snap, because of the sudden jerking force without the ability to recoil and absorb the shock.
The same principle can be applied to your Achilles tendon. If a sudden force is placed on the tendon (like when you sprint or jump) and it is unable to absorb the shock or recoil, it can tear.

What is the difference between an Achilles tendon tear and an Achilles tendon rupture?

Repetitive overuse of Achilles tendon will lead to the structure being worn out and inflamed. Now, when you walk or run it leads to pain and inflammation. Pushing through this pain and inflammation will lead to further damag and degeneration of the Achilles tendon structure. It is like being caught in a vicious cycle. Now, your Achilles tendon can start to tear due to the weak and disrupted tendon fibre network. It might start with a small partial tear, but it could progress to a full tear if it isn’t treated the right way.

The term ‘rupture’ can be described as a complete and sudden break or tear. So the term Achilles tendon rupture is used when your Achilles tendon has been torn completely and suddenly. You will feel like you’ve been kicked in the back of your heel and hear a loud popping or snapping sound. Afterwards, you won’t be able to walk at all. Your foot will simply feel floppy, like it has no strength. With a ruptured Achilles tendon, your calf muscles will have no anchor and they’ll be pulling on nothing. Thus they won’t be able to help move your foot.

If your Achilles tendon didn’t tear completely, we call it a partial tear. This means that the anchor is still intact and you will still be able to move your foot. However, it will be very painful and weaker than usual.

Different areas of Achilles tendon tears/ruptures

  • Insertional Achilles tear/rupture: This is where the Achilles tendon anchors its fibers directly onto the calcaneus.
  • Mid-portion Achilles tear/rupture: Anywhere along the Achilles tendon, but more than 4 centimeters above the heel and before the tendon and calf muscles connect.
  • Musculotendinous junction: This is the part where the calf muscles merge together with the Achilles tendon. A tear in this part of your Achilles tendon might even cause you to wonder if you’ve torn your calf muscle, because it affects muscle tissue as well.
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Causes and risk factors for Achilles tendon tears

Causes

A sudden increase in force

Pushing yourself off the ground during high jump.

Sudden stretch

Stepping into a hole in the ground

Running further and faster

Sprinting the last 100 m of a 10 km race

A change in your exercise routine

Starting to train for a marathon when you haven’t really jogged in a while

Changes to the surface on which you exercise

Jumping and landing on hardwood floors vs. concrete floors

Shoes

Shoes that are worn out or not giving enough support can be just as bad as new shoes that you aren’t used to.

Overuse and overload of your Achilles tendon

Continuing to train even though you’ve injured your Achilles tendon.

Sport that involve running, jumping, sudden starts and stops or changes of direction

E.g. rugby, athletics, soccer and tennis.

Direct trauma

When someone kicks you directly on your Achilles tendon

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Risk factors

Risk factors for Achilles tendon tears

Risk factors are not direct causes, but when combined with overuse and overload can speed up the cycle of tissue damage and delay healing of your Achilles tendon.

Problems with foot and ankle alignment

Increased pronation of your foot changes the angle at which your calf muscles and Achilles tendon need to contract, which could make it more prone to injury and pain.

Previous injuries

Calf muscle tears or injuries to your foot and ankle can make you more prone to an Achilles tendon tear.

Walking pattern

Walking with a limp or walking with a rigid foot instead of the normal heel-toe action will put more strain on your calf muscles and Achilles tendon.

Calf muscle strength

The strength of your calf muscles will directly influence the amount of tension on your Achilles tendon.

Flexibility

Lack of flexibility of your calf muscles puts more strain on the Achilles tendon.

Body weight

This influences the amount of load that your lower leg and Achilles tendon has to carry.

Age

Flexibility of all soft tissue tends to decrease with old age

Hormones

Certain levels of hormones can influence the flexibility of ligaments and tendons

Diabetes

Diabetes can lead to circulation problems and slow healing of tissues

Poor circulation

Certain health conditions cause poor blood circulation in your body and can slow down healing of tissues

Use of certain medications

It has been shown that certain medications like antibiotics (Fluoroquinolones) can weaken the structure of tendons

Steroid/cortisone injections

Doctors sometimes inject cortisone into a sore joint or tissue, to reduce pain and inflammation. However, this medication can weaken the tendons and predispose tendons to ruptures.

Symptoms of an Achilles tendon tear

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Tests that you can do to see if you have torn your Achilles tendon

  • Stand comfortably
  • Give a big step forward with one leg and lean forward on it (almost like doing a lunge)
  • Make sure you keep the heel of your back foot flat on the ground
  • Repeat the same test with your other leg and compare what you felt
  • If you feel pain or stiffness in your Achilles tendon or calf of your back leg it could be a sign of an Achilles tendon tear or rupture
  • Pain at the base of the heel: insertional Achilles tendon tear
  • Pain in the middle of the heel: mid-portion Achilles tendon tear
  • Little pain and no limit in range of your movement (feeling that your ankle can go on stretching forever) could be a sign of a complete Achilles tendon rupture
  • Stand with your legs shoulder width apart
  • Make sure you put equal weight on both legs
  • Lift your heels up simultaneously so that you are standing on your toes
  • Lower back down
  • Do ten repetitions, lowering the heels down slowly (eccentric) then going onto toes again (concentric)
  • If you have pain in your Achilles tendon or calf it could be a sign that you have an Achilles tendon tear or calf muscle strain
  • The region of your pain will again indicate whether you have an insertional or mid-portion Achilles tendon tear
  • If you are unable to lift your heel off the ground, it could be a sign that you have a full Achilles tendon rupture
  • Lie on your back with both legs straight and relaxed
  • Point your toes (both feet)
  • If you have heel pain it could be a sign that you have an Achilles tendon tear
  • If you are unable to point your toes with one of your feet, it could be a sign of a complete Achilles tendon rupture
  • Lie on your stomach with your legs and feet completely relaxed
  • Ask someone to squeeze your calf midway
  • Repeat the test with your other leg as well and compare what happened
  • If your foot doesn’t move up and down naturally it could be a sign of a complete Achilles tendon rupture
  • If there is pain and some movement, it could be a sign of an Achilles tendon tear
  • Stand comfortably
  • Jump up in the air and land back down on the same spot
  • Repeat this five times
  • If you have heel pain or calf pain when you jump, it could be a sign that you have an Achilles tendon tear or calf muscle tear
  • If you are unable to jump, because it feels like you have no strength in one of your feet, it could be a sign of a complete Achilles tendon rupture
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How severe is my Achilles tendon tear?

Achilles tendon tears can be graded from grade 1 to grade 3, according to the severity and size of the tear. If a big enough force is applied from the start, it can cause a big tear in this strong tendon. But often, it starts out with a small grade 1 tear, and if the right steps are not taken to get the tendon back to a healthy state, it progresses. The structure of the tendon weakens over time and starts to degenerate and fray. In the end, your Achilles tendon can tear completely.

Grade 1 Achilles tendon tear

Let’s say you felt your Achilles ‘pulling’ while running uphill one day. After a while the discomfort seems to go away, so you continue with your run. The next morning you feel some Achilles tendon pain and stiffness, but it seems to ease during the day. Each day, the pain lingers and you find that you can’t run as fast as you used to. It’s uncomfortable, but it doesn’t stop you. It makes you worried and you wonder if you could have strained or torn your Achilles tendon.

When you ‘pulled’ your Achilles tendon during that first run, it was strained beyond it’s limit. This caused a grade 1 Achilles tendon tear. Usually, there are more than one tear with a grade 1 injury, but they are very small. Straining and overloading your Achilles tendon over & over again causes micro-trauma and leads to tears in the collagen network structure. Thus, the tendon is still completely intact, but injured and weakened. As with any injury, there will be some inflammation and swelling in the tendon as your body tries to start the healing process. It will cause you pain and stiffness and it affects the ability of the Achilles tendon to contract. That is why you feel like you can’t run as fast or as far as you used to.

Turning point

At this stage the tendon has the potential to recover completely if you manage it the right way. However, if you push through this pain every time, you are repeatedly causing micro-trauma to your Achilles tendon. It simply starts up the inflammation cycle again and leaves you in more pain.

Grade 2 Achilles tendon tear

A grade 1 Achilles tendon tear can progress to a grade 2 tear if you don’t give it a chance to recover. The collagen structure of the Achilles tendon won’t be as strong as it should be after a grade 1 tear. As your body tries to heal the tendon, extra collagen fibres are formed to heal the tears. This causes the Achilles tendon to become thicker and less flexible (almost like scar tissue). With repetitive strain, these fibres tear away from each other, like a cable or a rope where the individual strands fray. Applying more force will cause more damage and a bigger tear.

A grade 2 Achilles tendon tear can be classified as a partial tear. It means that a section of the tendon is torn apart, but there is still a large part that is intact. Now, can you imagine the strain on that piece of tendon that has to do all the work? Remember, with a bigger tear, there will be a bigger inflammatory reaction and more swelling. The sheath around the tendon has probably been partially torn as well and the bursa underneath the tendon could also become inflamed. You’ll have a protective calf muscle spasm, which leaves you to feel like you’ve injured your calf muscle as well.

The Achilles tendon changes permanently.

With an injury like this you will struggle to walk properly, nevermind run. Your calf muscles are hanging on by a thread, so you can imagine that each movement of your foot will be severely sore. Even if you give it enough time to heal, the scar tissue will cause your Achilles tendon to become thickened and stiff. At this stage you will feel a lot better, but you will struggle to get going with your running routine. You’ll feel an aching pain in your Achilles tendon each time you walk too far or go for a run and it will take longer to ease.

You can cause irreparable damage to your Achilles tendon if you push through your pain at this stage. The tendon structure gets weaker and degenerates, leaving you with problems like Achilles tendonitis. It is a vicious cycle that keeps your pain and inflammation going.

Grade 3 Achilles tendon tear (rupture)

An Achilles tendon rupture could happen to a completely healthy tendon due to a severe traumatic force like a sudden fast sprint. But often the structure of the tendon has simply weakened, sometimes without you even knowing about it, and one day it simply snaps.

With an injury like this, you’ll know that you’ve torn something. It leaves you with a floppy and useless foot, because your calf muscles has nothing to anchor them to your heel. You could either feel very little pain, or feel extreme pain with lots of swelling and bruising.

Don’t let your Achilles tendon tear progress to a full rupture. Let us walk this road of recovery with you and prevent if from getting to this point.

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Diagnosis

Physiotherapy diagnosis

We are confident that our physiotherapists are able to diagnose your Achilles tendon tear. We have the necessary experience to differentiate between a partial Achilles tear and an Achilles tendon rupture. Doing a full clinical assessment and getting the necessary information about your pain is the starting point.

Understanding the intricacy of the biomechanics of walking, running and jumping is important and we use this to look at the bigger picture. Different factors will contribute to each patient’s Achilles tendon pain. Therefore, we look at what is important to you and what you would like to achieve with your training.

During your physiotherapy evaluation, we will stretch and stress your Achilles tendon, test the strength of your calf muscles and evaluate your foot and ankle movements. This way we’ll be able to know how severe your injury is and how long it will take to recover. Thorough evaluation makes our physiotherapists the best at diagnosing this type of problem.

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X-rays

X-rays can be helpful to exclude fractures of any bones in and around your foot and ankle, especially if you have had a traumatic injury. However, it won’t show any evidence of an Achilles tendon tear or rupture.

Children have softer bones and are still growing. In a child, the Achilles tendon anchors onto the heel bone and onto a growth plate. This means that continuous strain and injury to the Achilles tendon can cause pain, inflammation and damage to the growth plate itself. In this case, taking an x-ray will be an option.

If your physiotherapist feels that it’s necessary to refer you for X-rays it will be discussed with you.

Diagnostic ultrasound

This is the preferred test to establish if you have an Achilles tear. Ultrasound imaging will also be able to differentiate between a partial Achilles tendon tear and complete rupture. We will be able to see if there are loose strands or micro-tears by the amount of fluid collection on the imaging. Ultrasound will also show collagen integrity as well as bursa swelling.

An ultrasound will be sufficient to determine what we need to know and confirm your diagnosis. Your physiotherapist will be able to refer you to the right place to get an ultrasound.

MRI

Doing an MRI to confirm an Achilles tendon tear is expensive and not always necessary from the start. You can only get an MRI done if you are referred by a specialist. If your physiotherapist feels that it is necessary to refer you to a specialist, it will be discussed with you.

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Why is my Achilles tendon pain not getting better?

Treatment for Achilles tendon tears is something that takes a very long time because tendons heal a lot slower than other structures. A torn Achilles tendon is the type of injury that will require you to change your whole routine to give it a chance to adapt to the work that it has to do.

On one hand your Achilles tendon pain feels better when you rest, but if you rest too much and too long, your muscles become weaker, joints become stiff and you compensate by using the wrong movement patterns. You start to limp or run differently to avoid the pain, but that just leads to more problems.

On the other hand, your Achilles tendon pain feels worse if you push through the pain. Increasing your speed, changing your shoes or even changing your route to run uphill more often, are all things that increase the load on your Achilles tendon.

You can create a cycle of damage if you constantly overload or overuse the tendon before it heals. An overused or overloaded Achilles tendon will cause pain and inflammation. The structure of the tendon becomes weaker and that just makes it easier to tear.

Do you feel stuck, not knowing whether it is safe to exercise or not? Have you wondered if you’ve ruptured your Achilles tendon? Early diagnosis is very important. Don’t wait too long before you see a physiotherapist and don’t push through pain!

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What NOT to do

  • Do not take anti-inflammatory medication continuously

  • Manage the injury with medication alone

  • Stretch too hard

  • Exercise through the pain

  • Do not ignore calf pain or heel pain that gets worse (it could be an sign of a deeper problem)

  • Leave it untreated, if you are uncertain of the diagnosis, rather call us and be safe

  • Don’t rest the whole time and stop with all forms of exercise

What you SHOULD do

  • Rest as needed, initially

  • Avoid movements that is flaring up your pain, like running or jumping

  • Make an appointment to confirm the diagnosis and determine how severe the Achilles tendon tear is

  • Change your activity or sport for a while to give your Achilles tendon time to adapt to the load

  • Finish your treatment and rehabilitation programme for better long-term results

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Making it worse

  • Walking up a ramp or incline

  • Climbing stairs

  • Running uphill

  • Stair running drills

  • Sprinting

  • Running

  • Suddenly changing direction

  • Driving

  • Jumping or skipping rope

  • Wearing high heels or shoes that rub against your heel

  • Getting up to walk after sitting for a while

  • Changing or increasing your pace and mileage when you run

Problems we see when patients come to us with Achilles tendon tears

Waiting too long and not getting a proper diagnosis

A common problem we see is that patients wait too long before they seek help for their Achilles tendon pain. By the time they come to see us, they have had pain for months and they even tried to exercise with pain. Now, the tendon structure has already started to change and weaken, leading to recovery taking so much longer.

If you don’t get a proper diagnosis from the start, it wastes time and your pain will simply return. Over time, you’ll wonder if you’ve torn or ruptured your Achilles tendon and the pain will bother you more and more. Now, you think twice, like going for your daily run. Because you anticipate that you’ll have pain. The longer you wait, the bigger your chances are of causing a more serious tear in your Achilles tendon.

Trying out, but not completing different forms of treatment

Often, patients try to get relief by taking medication or getting a cortisone injection. They hope that medication and things like massages, foam-rolling or stretching can ease their pain. However, these treatments will only be a temporary solution. You are not addressing the root of the problem by trying any of these treatments in isolation.

Wearing a moonboot or ankle brace might feel like it gives your heel and your foot the rest it needs, but once you take it off, it feels even worse. The same can be said about using insoles. Be careful to change your shoes and get insoles too quickly. It will change the biomechanical way that your foot and ankle moves when you walk or exercise. This can put strain on other structures and lead to more pain. Long-term use of these things will cause you to become dependent on them.

And then, a lot of people tend to feel better halfway through their physiotherapy treatment program, so they stop. You won’t give your Achilles tendon enough chance to recover and your muscle strength and ankle mobility won’t be back on the level where it should be. Patience is key.

Resting too much or too little

Resting too much leaves you weaker than before. Moving too much causes extra pain, inflammation or even a more serious Achilles tendon tear. Finding the balance between resting and doing a safe level of training is key!

Let us help you get the right treatment for your heel pain so that it doesn’t stop you in your tracks.

Physiotherapy treatment

We have seen many patients with Achilles tendon tears and we can provide the best possible treatment for Achilles tendon pain that will lead to faster recovery. We understand that you feel anxious to get back to your normal activities, so that is why we are here to provide guidance and answers. You will be provided with a very effective and structured plan of action that treats all the aspects of the problem and get you back to walking comfortably or running with confidence. However, it’s important that you commit to the treatment plan, as this improves your chances of successful long-term recovery.

The basic structure of our treatments:

  1. Determine if it is your Achilles tendon that has been injured
  2. How bad is it injured?
  3. Protect it from further injury
  4. Give it time to heal correctly
  5. Strengthen the tendon and surrounding calf muscles
  6. Re-evaluate to monitor progress

We will be looking at different aspects like testing the ability of your Achilles tendon to do the work that it should be doing. Other aspects like muscle strength, range of motion, flexibility and stability will also be measured. Treatment techniques will include: soft tissue massage, joint mobilisations, dry needling, strapping, laser therapy, nerve mobilisations and guiding you through a rehabilitation program of gradual strengthening, lengthening and conditioning of the tendon.

Your best bet would be to come and see us for comprehensive rehabilitation.

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Phases of rehabilitation

1st Phase: Protection and initial healing

Protect

Patients tend to push through their pain and even continue to exercise with Achilles tendon tears. This causes continuous inflammation and pain. Protect your Achilles tendon by avoiding painful movements initially. You might have to use crutches to take weight off of your leg.

Avoid anti-inflammatory medication

Avoid using anti-inflammatory medication if possible as it delays healing. Ideally, use only pain medication without an anti-inflammatory component in the initial phases of your injury. That way, your pain will be under control, and with time you can taper off and stop taking the medication completely.

Compression and Ice

Strapping can provide good support for the painful area, which in turn will decrease your pain. Applying ice to the sore area, can help to numb the pain and relieve swelling.

Information

Make sure that you get information from the person that is treating you. Its important to understand what you should and shouldn’t do. If you are informed, you can also make the right decisions. Your body knows best, so avoid too many types of treatments at once.

Load

Let pain guide you to gradually return to your day to day activities. Initially, it is tricky to know if it is better to rest or to move, but finding a balance between the two is the best you can do.

2nd Phase: Promote tissue healing and establish a pain-free range of motion

We monitor the progress of healing in your Achilles tendon and we will help to accelerate the healing process on a cellular level, using dry needling, laser and ultrasound. As healing takes place, we want to see not only improvement of your pain, but also improvement in the Achilles tendon’s ability to contract (shorten and lengthen).

You’ll be able to do certain movements (like stretching your toes up) to a certain point, before your pain starts. This is your pain-free range of movement. You are safe to move in this range as it won’t disturb the healing process. Our exercises will be targeted between these boundaries of your pain. With time, your foot movements should become less sore to do.

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3rd Phase: Weightbearing and taking load

When you stand or walk, you are putting your body’s weight on your leg and foot. Your Achilles tendon is taking some of this weight as well and it should be able to handle tensile, elastic and compression forces. You’ll start to take more weight on your leg as your pain improves and we’ll evaluate your walking pattern, to make sure you don’t get used to limping.

Isometric muscle contractions is something that we use to help your Achilles tendon get used to shortening and lengthening again. It’s a type of muscle contraction that doesn’t involve big movements. This way we can start the process of strengthening your calf muscles without compromising the healing of your Achilles tendon.

4th Phase: Full range of movement and muscle strength

During this stage of treatment for your Achilles tendon tear, you should have full range of movement of your foot back and you should be getting stronger. The new collagen fibres of your Achilles tendon should be lengthened and orientated in such a way that it doesn’t decrease your flexibility. That way your Achilles tendon should also be able to shorten and lengthen smoothly. During this phase we will use: massage, stretches, myofascial release and joint and neurodynamic mobilisations.

Once this smooth contraction has been restored, your calf muscles will also be able to function at their optimal strength again. We will progress your exercises more and more, adding resistance, doing more repetitions and building your overall strength. Now, you should be able to walk comfortably and even climb stairs.

5th Phase: Eccentric control and balance

It is one thing to feel yourself getting stronger, but another thing to do movements with control. While walking, running or jumping, you need control and stability. This is where balance comes in as well.

The type of exercise we use during this phase of rehabilitation is called eccentric exercises. Muscles and tendons are able to contract and shorten concentrically, but they are also able to slowly lengthen eccentrically. That is where your control comes from. You’ll do exercises on one leg to improve balance and stability. Climbing stairs is a good example of something that you need balance and stability for.

6th Phase: Power, speed and endurance

Gradually returning to your routine and getting used to the intensity of your usual activities is a big part of your recovery. This way, we can determine if you are ready to return to fully working and training. Working the whole day or being on your feet will require some endurance. Other things like running will require speed and power. Your Achilles tendon should be able to keep up with the demands of your body. Your physiotherapist will guide you to challenge your Achilles tendon and calf muscles past their normal boundaries to determine how your body reacts. Ultimately we prepare you to return to participating in your sport. Whatever must be done – we’ll get you there. Sprinting, jumping, hiking and much more.

7th Phase: Sport Specific Training

This is the final stage of rehabilitation. Your physiotherapist will still continue with myofascial release, trigger point release and electrotherapy modalities where needed, but sport rehabilitation is most important during this phase.
Depending on your sport, your physiotherapist will tailor specific exercises that will help strengthen the muscles pertaining to your sport. A successful outcome is when you can participate at full power and speed, not to mention the benefits of minimizing your chance of recurring Achilles tendon injuries.

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Healing time

If you keep in mind the slow healing rate of tendons, then you can plan on recovery taking anything from 6 weeks to 3 months, depending on the severity of your Achilles tendon tear. Every patient is different and will have different goals. You could experience flare ups in between but if the full rehabilitation program is followed, we aim to get you back to living your life as soon as possible.

A full Achilles tendon rupture can take anything from 6 to 12 months to recover, depending on the success of rehabilitation and surgery.

Initially, you will need to see your physiotherapist twice a week in the effort to get your levels of pain under control. Thereafter, your treatments will be spread out to once a week or every second week. This way, you will have enough time in between to continue with your rehabilitation program. You only spend an hour at a time with your physiotherapist. How fast you recover will greatly be up to you.

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Other forms of treatment

  • Your doctor will probably prescribe anti-inflammatory medication or give you a voltaren injection to ease the pain. Both of these medications will give temporary relief to the pain and stiffness that you are experiencing. However, it will not be the solution to your problem. Once the effect of the medication wears off and you try to get back to working or exercising, your pain could simply return.
  • Getting an alignment done of your leg or foot in the hopes of improving your heel pain and stiffness, will not improve the state of the Achilles tendon or change your pain. It could even worsen the injury or trigger an inflammatory response. You need to look at the bigger picture.
  • A biokineticist will be able to help you in the final stages of your rehabilitation or to get you back to actively training for your sport.
  • Wearing a moonboot or insoles to ease the pain of your Achilles tendon tear, won’t be the solution to your problem. It might work on one of the numerous factors that influence your tendon, but doesn’t treat the tendon directly.

Is surgery necessary for an Achilles tendon tear?

Generally, surgery is not something we consider with a partial Achilles tendon tear. If you have a complete Achilles tendon rupture, you will need surgery to re-attach the two ends of the tendon. There has been instances where the Achilles tendon regrew after a few months without surgery. However, surgery speeds up the process and success rate for re-alignment of the Achilles tendon.

With any surgery there are risks involved, so make sure you discuss this with your surgeon and weigh out all the options. Your rehabilitation process takes about exactly as long as it would have been without having had the surgery in the first place.

What else could it be?

Plantar fasciitis

Pain at the bottom of your heel or pain stretching over the arch of your foot. It is especially painful when taking the first few steps in the morning.

Haglund deformity

A prominent bony point at the back of your heel bone (calcaneus) that feels especially painful and irritated when you wear tight shoes that rub against the back of your heel.

Sever’s disease

A common cause of heel pain in growing children and adolescents. It is inflammation of the growth plate at the back of the heel bone due to repeated stress and tension of the achilles tendon on the heel bone.

Calcaneal fracture or stress fracture

It is a hairline crack or fracture of the heel bone (calcaneus). It usually happens due to overuse (like marching) or a hard fall directly onto the heel. Walking, marching or running will be painful.

Posterior ankle impingement

Pain at the back of your ankle or heel due to compression of the bones, joints and soft tissue structures. Compression like this happens during repeated and forceful plantarflexion (pointing your toes). It often affects ballet dancers.

Partial or complete calf muscle tear

A sudden, sharp pain or even snapping sound that you feel in your calf muscle. A calf muscle strain/tear can happen during sports, sprinting or even walking. Walking, climbing stairs or jumping will be painful.

What else could it be?

  • Torn Achilles tendon
  • Achilles tendon strain
  • Partial Achilles tendon tear
  • Achilles tendon rupture
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