Achilles tendon – structure, injuries, and treatment. Learn more!
The Achilles tendon is the largest tendon in the human body. It enables proper movement, allows for dynamic motions, and absorbs mechanical loads. Although this structure is remarkably strong, it has poor blood supply, which increases the risk of damage - often triggered by sudden movements or intense physical effort. What are the most common Achilles tendon injuries? Where exactly is it located? Is non-surgical treatment of a torn Achilles tendon possible? And how does home treatment for Achilles tendon inflammation work?
Table of contents
- Achilles tendon - what is it and what role does it play?
- Common injuries and disorders of the Achilles tendon
- Achilles tendonitis
- Partial and complete ruptures of the Achilles tendon
- Achilles tendinopathy
- Warning signs of Achilles tendon problems
- How to diagnose Achilles tendon injuries
- Proven treatment methods for Achilles tendon injuries
- How to prevent Achilles tendon injuries
- Supplements for healthy tendons
- Summary
Achilles tendon - what is it and what role does it play?
The Achilles tendon (Latin: tendo Achillis), also known as the calcaneal tendon, is both the strongest and the largest tendon in the human body. It forms a broad, thick structure at the top that gradually narrows and thickens downward, ending in a clear expansion where it attaches to the heel bone (calcaneus). Located at the back of the lower leg above the ankle joint, it connects fibers from two muscles: the gastrocnemius and the soleus.
The tendon is made of collagen fibers. It has limited elasticity and is a poorly vascularized and innervated anatomical structure. Despite that, it is highly durable, enabling normal walking, shock absorption, and dynamic actions such as jumping, running, and standing on tiptoe. It also plays a crucial role in walking and maintaining an upright posture.
The name “Achilles tendon” comes from the mythical hero Achilles, who, despite his strength and agility, had a vulnerable spot – his heel. In the case of the tendon, its weak point is its blood supply. Blood reaches the area through the posterior tibial and fibular arteries, but after the age of 35, circulation decreases. This weakens the tendon and increases the risk of injury during sudden movements.
Common injuries and disorders of the Achilles tendon
In recent years, Achilles tendon injuries have become more frequent, largely due to the rising popularity of active lifestyles among older adults. Unlike younger athletes, their musculoskeletal systems are less resilient to strain. Still, these injuries are not limited to older people – they are also common among young athletes who skip proper warm-ups or overload their bodies with excessive training. Achilles tendon pain can also result from overly intense workouts or insufficient recovery time between training sessions.
The most common Achilles tendon injuries include:
- Achilles tendonitis
- partial tear of the Achilles tendon
- complete rupture of the Achilles tendon
- Achilles tendinopathy
Achilles tendonitis
The Achilles tendon is surrounded by a protective sheath that reduces friction. However, because the tendon constantly changes its length while the sheath does not stretch, friction can occur, leading to irritation and inflammation. Achilles tendonitis can appear suddenly after a single incident or develop gradually due to repetitive strain.
It is often linked to factors such as:
- abnormal foot structure
- excess body weight or obesity
- weak calf muscles
- improper footwear
- calf muscle stiffness
- Haglund’s deformity
Typical symptoms include calf pain at the back of the leg, tenderness above the heel, and sometimes pain higher up along the tendon.
Partial and complete ruptures of the Achilles tendon
A partial tear usually results from high-intensity exercise or sudden movements. It involves partial fiber damage, leading to sharp pain in the back of the leg and difficulty moving, especially when standing on tiptoe.
A complete rupture, on the other hand, means the tendon fibers have been torn entirely – most often 2–6 cm above the heel bone. It typically occurs during activities involving forceful push-off movements, such as playing soccer. Other causes include sudden or excessive exertion. Symptoms resemble those of a partial tear but are much more severe and may include a distinctive snapping or popping sound during the injury.
Achilles tendinopathy
Achilles tendinopathy is a degenerative condition caused by repetitive overload. Micro-injuries lead to fibers detaching from cartilage, eventually forming calcifications known as enthesophytes. It may also result from tight calf muscles, excessive physical effort, poor recovery, or repetitive, monotonous movements. Symptoms include pain, tendon stiffness, and sometimes a cracking sensation.
Warning signs of Achilles tendon problems
Risk factors include excess weight, ill-fitting shoes, structural foot deformities, degenerative diseases, or prolonged immobilization leading to contractures and tendon shortening.
Common symptoms of Achilles tendon injuries include:
- swelling, redness, or inflammation
- pain when moving the foot
- a snapping or popping sound
- burning pain during activity
- tenderness to touch
- increased warmth in the area
- stiffness of the tendon
- calf pain
- limited range of motion and difficulty walking
How to diagnose Achilles tendon injuries
Achilles tendon injuries are diagnosed and treated by an orthopedic specialist, often in collaboration with a physical therapist. Diagnosis usually involves a physical exam and medical history, and in more severe cases, imaging tests.
Ultrasound (USG) is the most common diagnostic tool, as it is quick, non-invasive, and effective in detecting tendon damage. MRI is also used when more detailed evaluation is needed, although it is less available and more costly. Functional tests may also be performed to assess how the injury affects everyday activities.
Proven treatment methods for Achilles tendon injuries
Not all injuries require surgery – sometimes home remedies are enough, while in other cases, surgical or specialized medical treatment is necessary.
Home remedies
At the first sign of pain, it is important to stop the activity causing it. Cold compresses (ice packs, cooling gels, or cold water) help reduce swelling and discomfort. If the pain is mild, stabilizing bandages, rest, or switching to low-impact activities like swimming or cycling may be sufficient. Over-the-counter cooling gels, anti-inflammatory creams, and pain relievers can also help.
Medical intervention
Severe injuries, such as a complete rupture, often require surgical repair to restore normal foot biomechanics. Surgery may also be recommended if tendonitis symptoms persist for more than six months despite conservative treatment. One such procedure is gastrocnemius recession, which lengthens the calf muscle and reduces stress on the tendon.
Physiotherapy and rehabilitation
Physical therapy often includes eccentric training, foam rolling, and dynamic stretching. Manual therapies, such as functional massage or soft tissue mobilization, can also be beneficial. Physiotherapy treatments may include:
- cryotherapy (to reduce swelling and pain)
- laser therapy (to support tendon healing)
- ultrasound, shockwave therapy, and taping techniques
Recovery and rehabilitation after Achilles injuries
After surgery or prolonged conservative treatment, rehabilitation is crucial for regaining full mobility and preventing re-injury. It is important not only to heal the tendon but also to address the root cause of the problem, such as poor footwear or improper foot alignment.
Strengthening and stretching exercises tailored to the patient’s needs are key. Kinesiotaping, braces, or compression sleeves may also be recommended to provide additional support and stability during recovery.
How to prevent Achilles tendon injuries
Because Achilles tendon injuries can be painful and require long rehabilitation, prevention is essential. Regular calf stretches, gradual increases in training intensity, and properly fitted footwear significantly reduce risks. Strength training for the calf muscles and proper running technique are also highly recommended.
Supplements for healthy tendons
Joint and tendon health can be supported with supplements, particularly for athletes exposed to repetitive stress. Collagen (a key component of the Achilles tendon), glucosamine, and chondroitin are widely used. Herbal remedies such as arnica, fenugreek, or turmeric may also help reduce inflammation and support tendon resilience.
Summary
The Achilles tendon is the body’s largest tendon, essential for movement and posture. Despite its strength, it is vulnerable to injuries such as inflammation, partial tears, or ruptures – especially when exposed to sudden or excessive strain.
Home remedies may help with mild cases, but severe injuries often require medical attention, including surgery and rehabilitation. Preventive care – such as stretching, strengthening exercises, and proper footwear – plays a crucial role in avoiding injury. Supplements and herbs may also provide additional support for tendon and joint health.
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