| By Dr. Charles Ruotolo
Photo credit: Goa Novi




The Achilles Tendon is one of the longest tendons in the body, and it stretches from the calf muscles all the way down to the heel. The Achilles Tendon is the string of tissue that can be felt above the ankle on the back of the heel. This tendon is responsible for our ability to point our toes to the floor or flex and extend our foot. Unfortunately, because it is such a large tendon, it is also more susceptible to injury.

Due to the high velocity initiated in tennis by the lower extremity through the contraction of the calf muscles, injuries to the Achilles Tendon in tennis are common. In fact, in a 2013 review of more than 400 Achilles Tendon ruptures in patients under the age of 55, 13 percent of these injuries were from tennis. Also, there is a 5.5 percent incidence of Achilles Tendon ruptures in tennis players over the age of 40.

Causes of Achilles Tendon injuries
Most cases begin though inflammation, which is not the true pathology. In actuality, it is tendinosis or degenerative tearing at the microscopic level that occurs and causes pain. In a severe injury, even the slightest pressure put on the tendon could cause it to rupture or tear.

There are a variety of other causes for an Achilles Tendon injury, including, but not limited to:

►Chronic overuse, especially jumping and/or walking uphill

►Wearing high heels

►Tight leg muscles and tendons

►Increasing your level of physical activity too quickly

►Flat feet (fallen arches), also known as overpronation. In this case, the step causes a collapse of the arch, which stretches the tendons and muscles.

The tendon is more likely to be injured with sudden, quick movements, where abrupt muscle tension causes excessive pressure on the tendon. 

Three signs you may have an Achilles Tendon injury
1. There will be pain along the back of the foot and around the heel, especially during stretching exercises or when standing on your tiptoes. In cases of tendinosis, the pain starts minimally, but gradually gets worse over time. The pain is usually worse when you first get up in the morning and initially improves, but then worsens as  activity continues. A ruptured or torn tendon will cause immediate and intense pain. This might be associated with tenderness, swelling and stiffness as well.

2. Hearing a snap or pop at the time of the injury.

3. Difficulty with pointing toes to the floor or extending your foot. This will be nearly impossible with a ruptured or torn Achilles Tendon.

Dr. Charles Ruotolo

<p>Dr. Charles Ruotolo is a Board-Certified Orthopedic Surgeon and the founder of Total Orthopedics and Sports Medicine with locations in Massapequa, East Meadow and the Bronx, N.Y. Dr. Ruotolo completed his orthopedic residency program at SUNY Stony Brook in 2000. After his residency, he underwent fellowship training in sports medicine and shoulder surgery at the prestigious Sports Clinic of Laguna Hills, Calif. He is also a fellow of the American Academy of Orthopedic Surgeons. As an Associate Master Instructor of Arthroscopy for the Arthroscopy Association of North America, Dr. Ruotolo actively teaches other orthopedic surgeons advanced arthroscopic skills in shoulder surgery. As an avid researcher he has also published multiple articles on shoulder injuries and shoulder surgery in the peer review journals of Arthroscopic Surgery and of Shoulder and Elbow Surgery. For more information, visit <a href="http://www.totalorthosportsmed.com" onclick="window.open(this.href, 'wwwtotalorthosportsmedcom', 'resizable=no,status=no,location=no,toolbar=no,menubar=no,fullscreen=no,scrollbars=no,dependent=no'); return false;">www.totalorthosportsmed.com</a>.</p>