The Achilles tendon is the longest tendon in the human body, connecting the heel to the calf muscles.

Because of its placement and strength, the Achilles tendon is vital to walking, running, jumping, and standing on your toes.

An injury to this important tendon can keep you off your feet for weeks. So, when do you know if you suffer from an Achilles tendon injury and what kind of treatment can you expect?

Duke Orthopaedics’ foot and ankle specialist, Selene Parekh, MD, discusses Achilles tendon injuries and treatment options available to get you back on your feet.

What Does the Tendon Do?

Selene Parekh, MD, MBAThe Achilles tendon functions to bring the ankle downward, similar to the motion of pressing on the gas pedal. 

With jumping activities, the Achilles tendon sees forces eight times that of one's body weight. With sprinting activities, that force increases to 12 times that of one's body weight.

Achilles tendon tears or ruptures are commonly seen in weekend warriors and those who participate in sports with a lot of push-off actions. 

Where Does the Injury Occur?

The Achilles tendon is prone to injury in the area known as the watershed area.  The watershed area is the area approximately two to six centimeters above where the tendon attaches to the heel bone.

The blood supply to the tendon is low in the watershed area, so the tendon has a hard time healing itself. Most Achilles tendon tears will occur in this area.

What Does an Achilles Injury Feel Like?

If your Achilles tendon tears, you may feel a sudden pop in the back of the ankle and a rush of blood. It might feel like someone has kicked you in the back of the ankle. 

Many people experience a loss of strength in the foot when trying to stand on the ball of the feet.  Pain, swelling, and bruising are also common. 

If you have experienced any of these symptoms and are concerned about an Achilles tendon tear, you should see a medical professional within hours or days of the injury.

How Is This Injury Diagnosed?

Typically, your doctor will diagnose an Achilles tear simply by hearing about the history of the tear and viewing or touching the injured site. When carefully touching the Achilles tendon in the watershed area, a gap may be felt in the tendon.

Very rarely, a MRI or ultrasound is used to make the diagnosis. 

How Are Achilles Tendon Tears Treated?

Surgery is typically the best option for healing an Achilles tendon tear.

Non-surgical treatments are available for patients who are opposed to surgery or too sick to undergo surgery, for elderly patients, and for people who are not active. Non-surgical treatment involves wearing a short, non-weight-bearing cast for eight to 10 weeks, followed by extensive physical therapy.

Surgical options are recommended for athletes and people who wish to remain active. Currently, there are three surgical techniques that are offered:

• Open surgery. In the traditional open technique, the surgeon makes an 8-to-10-centimeter incision on the back of the ankle. The tear is cleaned out and the tendon ends are sutured together. 
• Percutaneous technique. In this technique, needles are placed through the skin and Achilles tendon, and the tear is sutured together. The tendon ends are never seen, so it is difficult to be sure that they are touching when the tendon ends are sutured together.
• Mini-open technique. In the mini-open technique, the surgeon makes a small incision two to three centimeters long on the back of the heel. In this technique, the tendon ends are seen and cleaned, and a small device is used to place the sutures in the tendon. The tendon ends are then brought together.

What Are Typical Treatment Outcomes?

Nonsurgical patients have an 18 to 20 percent chance of re-tearing the Achilles and often lose some push-off power. This is a concern for elite athletes. 

Patients who receive surgical treatment have an approximately 2 percent chance of re-tearing the tendon and have a more normal push off in the injured ankle.

-- Selene Parekh, MD, MBA, is a foot and ankle surgeon practicing at the North Carolina Orthopaedic Clinic.