Achilles tendon injuries

We’ll help you be able to put weight on your foot again, pain-free

When you climb stairs, your Achilles tendon can easily be subject to pulling forces of up to 500 kilograms. The Achilles tendon is actually the strongest tendon in the whole body, but high stresses frequently cause issues.

At Schoen Clinic, we identify the exact regions of your Achilles tendon that are affected during therapy. We treat an issue at the insertion of the tendon into the heel bone differently to when the tendon itself is affected or partially ruptured. In each case, you’ll receive the best possible care for your symptoms from our specialists.

Causes & symptoms

What Achilles tendon injuries are there?

The Achilles tendon can be damaged in different ways.

With an Achilles tendon rupture, your tendon is partially or completely ruptured. Depending on where exactly the rupture occurs, it is referred to as a proximal, distal or central rupture.

With insertional tendonitis, the region where your tendon enters the bone is inflamed. If long-term Achilles tendon inflammation occurs, painful calcifications can build up inside your tendon.

When a bony ledge on the top of your heel bone causes a rupture of the tendon, this is called a Haglund’s deformity. Most of the time, this also involves a chronically inflamed bursa. The long-term inflammatory irritation leads to further bone growth as well as the formation of scar tissue. This causes your heel to become thicker and pain to increase.

Some Achilles tendon injuries can also occur due to wear and tear. These mostly affect the middle tendon section.

Causes: how does an Achilles tendon injury occur?

The Achilles tendon is subject to high stresses each day. As a result, issues in this area are very common. People who practise sports and those over 40 are the most affected.

An Achilles tendon rupture is either a complete or partial rupture. This is often caused by sports activities, jerky tensile movements of the calf muscles, twisting of the foot or severe overbending of the ankle of the foot.

In some cases, this also leads to chronic irritation such as spondyloarthropathy or rheumatic arthritis, which thicken and soften the Achilles tendon in the region before it enters the heel bone. In addition, painful bursa inflammation frequently occurs. Even relatively small tensile movements can cause an Achilles tendon rupture.

An Achilles tendon rupture most often occurs when restarting sports activities after a long break. Sports which incorporate quick changes in direction, such as football, tennis and squash, carry the biggest risk of injury.

Furthermore, some antibiotics and cortisone preparations can change the tendon structure and therefore weaken the Achilles tendon when taken over long periods of time.

Symptoms: signs of an Achilles tendon injury

Depending on the type of injury, either your Achilles tendon itself or the area where the tendon enters the bone will be painful.

With an Achilles tendon rupture, your tendon is usually torn with a jerky movement and a loud noise similar to a crack of a whip. This can be very painful. The crucial foot flexor muscles in your calf will no longer have an insertion point. You will no longer be able to stand on your tiptoes.

Wear-related Achilles tendon injuries are accompanied by pain when initiating movement. This means there will be more pain when starting a sports activity. Once your tendon has “warmed up”, the pain will decrease. For this reason, your tendon may hurt more again after sports.

Insertional tendonitis and Haglund’s deformity almost always cause conflicts with your footwear due to chronic Achilles tendon inflammation. The bony ledge on the heel bone presses against the insertion point of the tendon, which is most painful when wearing closed shoes. With a partial or complete rupture, those affected report a feeling of their tendon being stabbed with a knife. They can no longer stand on their tiptoes, and sports are completely out of the question.

Chronic Achilles tendon changes often involve a thickening of the middle section of the tendon. If your tendon is ruptured, you will be able to feel a dent.

Diagnostics

Precise diagnostics for the right treatment

Because your Achilles tendon can be damaged in different ways, your individual therapy is based on different questions. In our diagnostics, we therefore clarify precisely how your injury occurred and what caused it.

Proven methods: ultrasound and MRI

X-ray images only show changes that indicate the corresponding injury in the case of Haglund’s deformity and insertional tendonitis. So our specialists often use ultrasound scans to diagnose ruptures. We opt for MRI scans for wear-related changes in particular, which allow us to clearly see which regions of the tendon have changed.