The Achilles tendon is a fibrous band of tissue that links the muscles in your calf to your heel. The strength and flexibility of this tendon are important for jumping, running, and walking. Your Achilles tendon bears a lot of stress and pressure during everyday activities, as well as during athletic and recreational play. If it becomes inflamed, swollen, and irritated, it's called tendonitis.

Achilles tendon injuries can be caused by the following:

Tendonitis might be due to overuse or damage to the area. It can cause pain down the back of your leg and around your heel. You might notice that parts of your tendon are getting thicker, tighter and hardening because of tendonitis. This will get worse if you don't treat it. There are two main types of tendonitis:

• Noninsertional Achilles tendonitis. Small tears in the middle fibers of your tendon start to break it down. This causes pain and swelling. This type of tendonitis usually affects active, younger adults.
• Insertional Achilles tendonitis. This damage occurs in the spot where your tendon meets your heel bone. Bone spurs (extra bone growth) often form with this type. This type of tendonitis can happen at any age, even in people who aren't active.

The tears in your tendon fibers can cause a complete or partial break (or tear) in your tendon. You might feel a pop or like someone kicked you in the leg that seems to come from the back of your heel or calf. This may be a tendon rupture, which needs immediate medical attention.

Anyone can develop an Achilles tendon injury. They're often linked to repetitive stress. The most common risk factors are:

• Smoking. This increases your risk of tendon tears and injuries by a lot.
• Age. Achilles tendon tears and injuries are most common in middle age or later.
• Treatment with certain medicines. This includes steroids (including cortisone injections at the Achilles tendon) and fluoroquinolone antibiotics such as ciprofloxacin (Cipro), levofloxacin (Levoquin) or moxifloxacin (Avolox). These antibiotics are commonly used for urinary and lung infections.
• Increased amount or intensity of an activity or sport.
• Starting a new sport.
• Tight calf muscles when starting an exercise or sport, which can place more stress on your tendon.
• Bone spurs on your heel, which can rub against the tendon.
• Wearing the wrong shoes when you exercise.
• Exercising on an uneven surface.

Common symptoms of tendon injuries include:

• Pain down the back of your leg or near your heel.
• Pain that gets worse when you're active.
• A stiff, sore Achilles tendon when you first get up.
• Pain in the tendon the day after exercising.
• Swelling with pain that gets worse as you're active during the day.
• Thickening of your tendon.
• Bone spurs on the heel bone.
• Difficulty flexing the affected foot.
• A pop sound or feeling of being kicked in the back of your leg and sudden sharp pain, which can mean a ruptured tendon.

Injury to the Achilles tendon causes pain along the back of your leg near the heel. It's important to get the right diagnosis so you can get the right treatment. Several common injuries can make your Achilles tendon painful or prevent it from working well.

To make a diagnosis, your doctor will consider:

• Your overall health and medical history.
• A description of your symptoms.
• A physical exam of your Achilles tendon to check for bone spurs, pain, and swelling.
• A test to see if you can move your ankle correctly (range of motion).
• Imaging tests, such as ultrasound, X-ray, or MRI. An X-ray shows bones and can show bone spurs and if the tendon has become calcified or hardened. Your doctor will usually use MRI to see how severe the tendon damage is and what treatment is best for you.

Treatment depends on how badly injured your tendon is. If it is Achilles tendonitis or strain, it may include:

• Rest.
• Ice.
• Nonsteroidal anti-inflammatory drugs for pain relief, such as ibuprofen or naproxen.
• Specific exercises to strengthen your calf muscles.
• Physical therapy.
• Eccentric strength training. This type of exercise helps strengthen your calf muscles to take pressure off your tendon.
• Low-impact activities, such as swimming.
• Heel lifts in shoes, orthotic shoes, a cast, a splint, or a walking boot.
• Extracorporeal shockwave therapy. This treatment uses high-energy shockwave impulses to help stimulate the healing process in damaged tendon tissue. This treatment isn't often used. However, your doctor may recommend it to see whether you can improve without surgery.

If these treatments don't work or if the injury is severe or complete, surgery may be considered. The type of surgery depends on the location and amount of damage to the tendon. It can also depend on other things, such as how sever the tendonitis is. Some of the surgical procedures used include:

• Surgery to lengthen your calf muscles (gastrocnemius recession).
• Surgery to remove damaged tendon tissue or bone spurs and repair the tendon (debridement).
• Surgery to remove your damaged tendon tissue, fix the remaining tendon, and give it extra strength by moving another tendon to the heel bone.

Problems from an Achilles tendon injury may include:

• Pain, which can be severe.
• Difficulty walking or being active.
• Tendon rupture or reinjury.

Other problems can happen because of the treatments used to care for an Achilles tendon injury. For instance:

• Sometimes cortisone injections can cause the tendon to tear.
• Surgery can lead to pain and infection.

These steps can help prevent injury to your Achilles tendon:

• If you smoke, stop smoking. Smoking increases your risk of Achilles tendon tears a lot.
• Warm up before exercising, playing sports, or doing other repetitive movements.
• Increase activity slowly, rather than all at once.
• Wear the correct shoes for your activities.
• Don't exercise on uneven surfaces.
• Stop activities that cause pain.
• Be aware of the risks of fluoroquinolone and steroids and exercise with caution if you're taking these medicines.

• Follow your doctor's advice to get rest and manage pain and swelling.
• Choose other ways to be active.
• Try low-impact activities that don't place a lot of stress on your tendon, such as swimming or bicycling, rather than a high-impact exercise like running.
• Always let your doctor know if these strategies don't help reduce pain, swelling, and loss of function.

Call your doctor right away if you hear or feel a pop sound and have sudden pain in the back of your leg or heel. Otherwise, schedule an appointment if pain or trouble moving affects your regular daily activities.

• Your Achilles tendon can develop tendonitis. This is when it becomes inflamed, swollen, and irritated.
• The Achilles tendon can also tear or rupture, which might feel like a pop or being kicked in the back of your leg that seems to come from the back of your heel or calf. This needs immediate medical attention.
• Anyone can develop an Achilles tendon injury and it's often linked to repetitive stress on the tendon.
• Achilles tendon injuries often cause pain, stiffness, and swelling in the back of your leg near your heel.
• Achilles tendon injuries can be treated with rest and medicines to help with the inflammation. Exercises often help too. If needed, surgery can be done to repair the tendon.
• You can help prevent these injuries by doing things like quit smoking, avoid medicines that put you at increased risk, increasing activity slowly, wearing the correct shoes for your activities, and not exercising on uneven surfaces.

Tips to help you get the most from a visit to your doctor:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your doctor tells you.
• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your doctor gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your doctor if you have questions, especially after office hours or on weekends.