Why does my Achilles tendon hurt? Learn How to Tell If It Is Torn. #Achilles#achillestorn#
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Why does my achilles tendon
Why does my achilles tendon hurt is common complaint among active people in a variety of levels of fitness. Many patients both young and old of achilles tendon pain hurting while running. The Achilles tendon is a fibrous band that runs from the gastrocsoleus complex (calf muscles) attaching to the calcaneus heel bone. If you experience pain while running it is pain it is typically experienced 2 to 6 cm above the heel bone along the tendon called a mid-substance Achilles tendonopathy. During runnning the achilles tendon takes 6-8 times the persons bodyweight as compared to walking and standing. In this region of the tendon it has relatively poor blood supply making it harder to heal and repair. Another type of achilles tendon injury is a insertional Achilles tendonopathy which is harder to treat and less common. Over the years the use of achilles tendinits and recently tendinosis have been used to describe pain in this region. We have attached the following breakdown to understand the differences between a tendinitis and a tendonosis.
In the case of an Achilles tendon tear especially in the case of a full thickness tear the onset is often reported as sudden onset and associated with a "pop" or "snapping" sound. Patients often complain of a feeling of being hit with a "ball" or "hammer" in the region of the Achilles tendon and sudden change in strength. It can occur from a sudden pivot and rapid change in direction that is done in sports like basketball, volleyball or football in the age group of 30-60 years of age. In the over 60 age group, relatively inactive and overweight the tears can occur with less intense activity like stepping off a curb especially in those who are less physically active. When observing a patient walking they have difficulty "pushing off" while walking but can compensate with over muscle groups and diagnosis may be missed in %25 of the time. In acute cases you may feel a gap in the tendon but less so in chronic cases.
When diagnosing an achilles tendonopathy, tendonitis or tendonosis all experience extensive loading of the tendon contributing in the early phases to inflammation and microtears in the same region of as the tendon tears then can progress to non-inflammatory condition which can eventually result in a tendon tear. Eventually the patient develops pain in this region but it doesn't occur with rapid movement in sports, a fall or trauma. This condition can slowly develop over time and worsen depending on the level of activity. A common misconception is the rest is necessary which can rapidly weaken the tendon and casue atrophy in the calf musculature. Depending on the person it may be tender to touch, focal swelling at the site, thickening of the tendon and warmth in the tendon. Most commonly this is referred to a tendonitis indicating inflammation which has been shown to be less common compared to a Achilles' tendonosis.
0:00 Start of Video
0:39 Understanding the Achilles Tendon
2:13 Different types of Achilles tendon conditions: tendonitis, tendonitis, tendonopathy
3:23 Understanding a Achilles tendon tear
10:57 Two Ways to Tell if you might have a full Achilles tendon tear
If we are sure it is an injury of the Achilles tendon the most important is to rule out if it is a partial or complete tear. In cases of a tear there is a limited window to manage it surgically and non-surgically. If the diagnosis is not made in 1-2 weeks it can cause the tendon to become retracted. When this occurs the tendon is further away from where it has been attached which can make it hard or impossible to manage conservatively through ankle boot immobilization or surgically repaired. Here are a couple a few tests that a physician will use to make a clinical diagnosis and when in doubt a MRI is ordered to confirm the physician suspicions.
How to test for an Achilles tendon tear using two tests
Thompson test or Squeeze test
The patient is positioned in prone with feet hanging off the table. Then gently squeeze calf on side. You should observe a the foot moving into plantarflexion and foot moving away from the table. A positive test is no movement at the ankle indicating a full tear of the achilles tendon.
Palpation of Achilles' tendon for gap for acute tears. Start moving your fingers along the tendon starting at the heel bone and about 2-6cm from the the achilles attachment you may notice a gap in the tendon. One way to compare this is to do this same assessment on the unaffected side.
In the case of an Achilles tendon tear especially in the case of a full thickness tear the onset is often reported as sudden onset and associated with a "pop" or "snapping" sound. Patients often complain of a feeling of being hit with a "ball" or "hammer" in the region of the Achilles tendon and sudden change in strength. It can occur from a sudden pivot and rapid change in direction that is done in sports like basketball, volleyball or football in the age group of 30-60 years of age. In the over 60 age group, relatively inactive and overweight the tears can occur with less intense activity like stepping off a curb especially in those who are less physically active. When observing a patient walking they have difficulty "pushing off" while walking but can compensate with over muscle groups and diagnosis may be missed in %25 of the time. In acute cases you may feel a gap in the tendon but less so in chronic cases.
When diagnosing an achilles tendonopathy, tendonitis or tendonosis all experience extensive loading of the tendon contributing in the early phases to inflammation and microtears in the same region of as the tendon tears then can progress to non-inflammatory condition which can eventually result in a tendon tear. Eventually the patient develops pain in this region but it doesn't occur with rapid movement in sports, a fall or trauma. This condition can slowly develop over time and worsen depending on the level of activity. A common misconception is the rest is necessary which can rapidly weaken the tendon and casue atrophy in the calf musculature. Depending on the person it may be tender to touch, focal swelling at the site, thickening of the tendon and warmth in the tendon. Most commonly this is referred to a tendonitis indicating inflammation which has been shown to be less common compared to a Achilles' tendonosis.
0:00 Start of Video
0:39 Understanding the Achilles Tendon
2:13 Different types of Achilles tendon conditions: tendonitis, tendonitis, tendonopathy
3:23 Understanding a Achilles tendon tear
10:57 Two Ways to Tell if you might have a full Achilles tendon tear
If we are sure it is an injury of the Achilles tendon the most important is to rule out if it is a partial or complete tear. In cases of a tear there is a limited window to manage it surgically and non-surgically. If the diagnosis is not made in 1-2 weeks it can cause the tendon to become retracted. When this occurs the tendon is further away from where it has been attached which can make it hard or impossible to manage conservatively through ankle boot immobilization or surgically repaired. Here are a couple a few tests that a physician will use to make a clinical diagnosis and when in doubt a MRI is ordered to confirm the physician suspicions.
How to test for an Achilles tendon tear using two tests
Thompson test or Squeeze test
The patient is positioned in prone with feet hanging off the table. Then gently squeeze calf on side. You should observe a the foot moving into plantarflexion and foot moving away from the table. A positive test is no movement at the ankle indicating a full tear of the achilles tendon.
Palpation of Achilles' tendon for gap for acute tears. Start moving your fingers along the tendon starting at the heel bone and about 2-6cm from the the achilles attachment you may notice a gap in the tendon. One way to compare this is to do this same assessment on the unaffected side.
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