The Achilles tendon (AT) is the toughest and strongest tendon and is responsible for supporting our entire body weight. Being subject to an amount of strain everyday makes the AT more susceptible to injury and its sensitive location means it takes longer to heal. Knowing the common ailments that hit this tendon and taking preventative measures against possible injury may save you months of inactivity. The two most common injuries are Achilles tendinopathy and AT rupture. The former can start with small tears in the tendon, which may initially go unnoticed or cause mild pain during activity. As the wear and tear progresses and more pressure is placed on the tendon, the pain will become more noticeable and last for longer periods of time. Your leg may feel weaker as your AT loses its tensile strength, becoming more prone to rupturing. For people who like to keep active, an AT rupture is the worst nightmare, namely because healing and rehabilitation take a long time. An AT rupture may be partial or complete and is often an acceleration injury, meaning a sudden start or stop in movement. This can occur while, for example, pushing off to reach for a tennis shot, jumping up or sprinting. While a partial tear may go unnoticed depending on its severity, a complete tear feels like someone has kicked you in your ankle. A loud 'popping' sound can be heard as the AT snaps. A physiotherapist assesses the state of your Achilles tendinopathy and sets a rehabilitation program that will ease you back into activity. As well as ultrasound treatment, temporary heel lifts may help reduce strain on the tendon while it is healing. Massage therapy may speed up the healing process and lessen the long-term effects of the injury on the tendon. People who suffer from Achilles tendinopathy require a lot of rest while undergoing treatment. An AT rupture will more likely require surgery to sow the AT ends back together, which means the leg will be immobile for several weeks. The leg will then be placed in a cast then a walking boot, after which patients undergo physiotherapy to regain strength, flexibility and movement. Generally after an AT repair, it takes six months to return to normal activity. Although patients can achieve almost full movement and function, an AT repair can never quite match nature's strength, and you will always have to be careful with your Achilles to avoid re-rupture tendon. Non-surgical repair of a torn AT may be an option for less active individuals who do not want to undergo the complications of surgery. A partial rupture will not be as debilitating and usually a cast is placed on the leg for several weeks without surgery. What are the causes of AT injuries? Recent evidence suggests that a genetic component is associated with AT injuries, with two genes found to control structural tendon components and the regulation of the tissue's response to mechanical load. In the future, specific genotypes associated with increased risk of injury to specific tendons and ligaments will be identified, and this may help prevent AT injury by identifying people at higher risk. Other factors are more mechanical and sports related, including overuse and repeated movements that may weaken the AT, such as intense running or racket sports. Other high-risk behavior includes not warming up before or cooling down after exercising; or suddenly changing your training program by increasing your distance or running uphill more often, for example. Playing strenuous sports such as squash and football can stretch the AT and may increase the risk of damage, especially for middle-aged people since the blood supply to the AT decreases with age. Men are also more prone to these injuries. Some medications are also thought to weaken tendon tissue making it more prone to rupture. These include Corticosteroids - either orally or by injection - and Quinolone antibiotics, such as ciprofloxacin and ofloxacina. For women, wearing shoes that do not provide enough cushion for the heal can also lead to injury to the AT as can switching from high heels (which shorten the AT) to flat shoes. Injuries to the AT can develop as secondary to another injury, such as an ankle sprain, when a person returns to sports too soon. Ideally, a carefully planned training program encompassing warming up, calf muscle stretches, wearing the correct shoes, massaging the calf muscle and AT before and after exercise may be the most important prevention strategy. It's also wise to consult your geneticist to see if you are at a higher risk. Dr May Meleigyholds a PhD in Immunology from the London School of Hygiene and Tropical Medicine, as well as a master's in toxicology/pathology and a bachelor's degree in pharmacology from London University. Dr Meleigy is a freelance medical/health writer and currently resides between London, Cairo and Dubai.
