The Achilles tendon is fibrous tissue that connects the heel to the muscles of the lower leg: the calf muscles. The Achilles tendon joins three muscles: the two heads of the gastrocnemius and the soleus. The gastrocnemius heads arise from the posterior portions of the femoral condyles. The soleus arises from the posterior aspect of the tibia and fibula. The bulk of the Achilles tendon inserts into the posterior superior third of the calcaneus. Some fibers course distally and continue to where portions of the plantar fascia insert into the plantar aspect of the calcaneus. Leg muscles are the most powerful muscle group in the body and the Achilles tendon is the thickest and strongest tendon in the body.

 

The Achilles tendon is fibrous tissue that connects the heel to the muscles of the lower leg: the calf muscles. The Achilles tendon joins three muscles: the two heads of the gastrocnemius and the soleus. The gastrocnemius heads arise from the posterior portions of the femoral condyles. The soleus arises from the posterior aspect of the tibia and fibula. The bulk of the Achilles tendon inserts into the posterior superior third of the calcaneus. Some fibers course distally and continue to where portions of the plantar fascia insert into the plantar aspect of the calcaneus.  Leg muscles are the most powerful muscle group in the body and the Achilles tendon is the thickest and strongest tendon in the body. This is the tendon that is just below the skin at the back of the ankle. As with most tendon injuries, this tendon may be injured. Forces up to 12 times body weight (9kN) may arise during sprinting. The Achilles tendon does not have a rich blood supply. The mesotenon supplies the major blood supply to the Achilles tendon. Contracting the calf muscles pulls the Achilles tendon, which pushes the foot downward. This contraction enables: standing on the toes, walking, running, and jumping.

Causes of Injuries to Achilles Tendon

• Over usage
  

• Misalignment

• Improper footwear
• Accidents can result in injury
• Some medications may have some side effects which lead to injury to Achilles tendon

Common injuries to Achilles tendon

• Achilles Tendinosis/Achilles Tendinitis
• Achilles Tendon Rupture

Achilles tendonitis is an inflammation of the tendon. It often results from a small stretch injury that causes the tendon to become swollen, painful and less flexibility than the normal tendon. It is a soreness and stiffness that comes on gradually and continues to worsen until treated. Pinching the Achilles tendon with the forefinger and thumb will indicate soreness. It is a common injury among runners. Untreated, this injury may fail to heal, or progress to a chronically painful condition.

There are several factors that can contribute to Achilles tendonitis.

• Increase in training
• Excessive hill running
• Stiff soles and excessive sole cushioning can result into the Achilles tendinitis

Ruptures of the Achilles tendon most commonly occur spontaneously in healthy, young, active individuals who are aged 30-50 years and have no antecedent history of calf or heel pain. It comes with a popping sound, and is debilitating. It usually occurs at a point 4-5 cm proximal to the calcaneus as the area above the calcaneus is the zone of poor blood flow in the tendon.

Signs and Symptoms

• Sudden severe ankle pain

• Ankle tenderness
• Ankle bruising
• Limping
• Difficulty moving foot
• Difficulty walking
• Difficulty running
• Painful walking

Risk Factors

• Poor conditioning
• Advanced age
• Overexertion

Diagnostic Investigations

• X-Ray
• MRI (Magnetic Resonance Imaging)
• Ultrasonography

Treatment and Drugs

• Ice packs should be put on the Achilles tendon for 20 to 30 minutes every 3 to 4 hours for the first 2 or 3 days or until the pain goes away
• Laser photostimulation
• Electrical stimulation
• Ultrasound
• Muscle strengthening
• Physical therapies
• The treatment options for a complete rupture of the tendon include surgery followed by casting, or casting alone.
• NSAIDs can be prescribed for pain alleviation depending on case to case basis