Repairing the Achilles tendon


The Achilles tendon is the strongest and largest tendon in the body.

The Achilles tendon transmits the force of the calf muscles to produce the push-off during walking, running, and jumping. It is extremely vulnerable to injury due to its limited blood supply and the numerous forces to which it is subjected.

The area of the tendon approximately 2 to 6 cm above the heel has the poorest blood supply, and therefore heals the most slowly. Obviously this is the area that is the most susceptible to injury.

Most injuries of the Achilles tendon do not result from recent acute injury, but develop gradually over weeks or months. These are ‘overuse’ or ‘misuse’ conditions caused by excessive and/or repetitive motion, often associated with poor biomechanics.

Continued long term aggravation can eventually lead to complete failure, with a resulting acute tear of the tendon.

Symptoms of Achilles’ injury are usually described as diffuse pain in or around the back of the ankle (from the calf to the heel). The pain is aggravated by activity, especially uphill running or stair climbing, and relieved somewhat by wearing higher-heeled shoes. Often, a recent increase in activity levels (such as running longer distances) or a change in footwear is reported by the sufferer.

Surgeons have noted that overused Achilles tendon tissue is dull, slightly brown and soft, in comparison to normal tendon tissue, which is white, glistening and firm. This is due to damage of the tendon collagen, not inflammation. This explains why anti-inflammatory strategies (such as drugs and corticosteroid injections) are not indicated for these conditions, and actually may interfere with tendon repair.

Achilles tendon injury is not due to inflammation, but an underlying degeneration of collagen tissues in response to mechanical overuse.

Complete return to function will require attention to range of motion, functional strength and possibly orthotic support. If a rupture of the tendon occurred surgical repair and a period of rest must occur before rehabilitation can begin.

Initial treatment also should include heel lifts to reduce the strain on the Achilles tendon, and manual soft tissue techniques to improve circulation.

In addition to appropriate foot and ankle adjustments, your chiropractor will also instruct in stretching of the tight and shortened calf muscle complex. Correct strengthening exercises can be demonstrated and monitored by your chiropractor.

Your chiropractor may also use acupuncture to stimulating healing of damaged tendons. Acupuncture may be used to help address muscular dysfunction, pain, and stimulate healing.

Achilles tendon problems often develop from poor foot and ankle biomechanics, and control of foot pronation (inward collapse of the ankle/foot) is needed to prevent recurrent injuries.

One of the most important long-term goals is to reduce any tendency to pronate excessively.

Properly fitted orthotics are quite useful in the long-term improvement of foot biomechanics and Achilles injuries.