Achilles Tendon Injuries

The Achilles tendon is the largest tendon in your body. It connects the muscles in the back of your lower leg to your heel bone (the calcaneus) and must withstand large forces during sporting exercises and pivoting. There are two main types of injuries that affect the Achilles tendon: 1) overuse and inflammation, called Achilles Tendonitis, and 2) a tear of the tendon.

Achilles Tendonitis

Achilles tendonitis often occurs when you rapidly increase the intensity of training or start new types of training when your body is not fully conditioned, e.g., adding uphill running to your training schedule or restarting training after a period of inactivity. You may experience mild pain after exercise that gradually worsens. Mild swelling, morning tenderness, and stiffness may also occur, but may improve with use. Severe episodes of pain along the length of the tendon several hours after exercise may also be experienced. Because other symptoms may be present, it is best to see your doctor for full evaluation of an Achilles injury. Treatment depends on severity and typically involves rest and nonsteroidal anti-inflammatory medications (NSAIDs) to relieve pain and inflammation. An orthosis (a brace) may be needed to relieve the stress on your tendon and support your ankle, or bandages may be applied to restrict joint movement. 

Surgery is sometimes an option to repair any tears and remove any inflamed or fibrous (toughened) tissues. Recovery in general includes rehabilitation to avoid future weakness in your ankle.

Achilles Tear

Your Achilles tendon may tear if it is overstretched, usually while playing sports. The tear may be partial or complete and most commonly occurs just above the calcaneus (your heel bone). A snap or crack sound may be heard at the time of injury. Pain and swelling near your heel and an inability to bend your foot downward or walk normally are signs that you may have ruptured your Achilles tendon. 

Surgery is typically needed for a complete rupture. After surgery, your ankle will be kept stable in a cast or walking boot for up to 12 weeks. A torn ligament may also be managed nonsurgically with a below-knee cast, which would allow the ends of the torn tendon to heal on their own. This nonsurgical approach may take longer to heal, and there is a higher chance that the tendon could re-rupture. Surgery offers a better chance of full recovery and is often the treatment of choice for active people who wish to resume sports.


To learn more about Achilles tendon injury, contact Annapolis Foot and Ankle Center. Please call to schedule an appointment 410-266-7666.


Stress Fracture

Stress fractures are tiny cracks in a bone caused by the overuse and the repetition of movements during exercise. When your muscles are fatigued, they become unable to absorb additional shock during exercise and transfer the overload of stress to the bone. This constant process causes tiny “microcracks” in the bone.

Stress fractures are most common in the weight-bearing bones of your lower legs. They result from increasing the amount and intensity of activity or from an impact on unfamiliar surfaces. For example, a tennis player who changes from a soft to hard court may experience a stress fracture. Athletes participating in tennis, basketball, track and field, and gymnastics are most susceptible to stress fractures, especially if they are not resting enough between training sessions.

Studies have shown that women are more at risk for stress fractures than are men. This appears to be related to nutritional deficiencies and a woman’s propensity for decreased bone mass density.

The most common signs and symptoms include swelling and pain that decrease with rest, and increase with activity. Also, there may be a spot that feels tender or painful when pressure is applied. A stress fracture is sometimes mistaken for a shinsplint (an inflammation of the tibia or shinbone that commonly affects runners). However, stress fractures are more serious.

The most important factor in managing your pain and healing the fracture is rest, which may be needed for 4 to 12 weeks. You may also have to modify other daily activities during these weeks. The next step, rehabilitation, includes a program of muscle strengthening and generalized conditioning. If pain persists, careful use of nonsteroidal anti-inflammatory medications (NSAIDs) may be helpful. However, these medications may limit bone repair and are therefore should be used cautiously. In most cases, stress fractures can be managed with these conservative measures. However, more severe fractures may require surgery to fix and prevent further injury to the bone, as well as to ensure proper healing. Recovery from this kind of surgery is approximately six months.

You may be at risk for a stress fracture if you:

  • Participate in high-impact sports
  • Have been told you have low bone density
  • Suddenly begin an intense training schedule
  • You are an adolescent (bones are not fully mature)

If you suspect that you have signs or symptoms of a stress fracture, if the pain is prolonged, or if there is no improvement with rest, please see your doctor for further evaluation and treatment.