You’ll feel pain of course, particularly as you take off from the injured leg, and also after sleep when you first stretch the slightly-healed scar tissue that has formed overnight (a ‘drop-foot splint’ can keep the Achilles stretched overnight and reduce this tightness). The initial pain may be sudden, and soon becomes chronic with further use.
If you carefully feel along the tendon you can often discover one or more small, tender nicks at the side of the tendon where there is a healing area of torn tissue.
Again, X-ray or ultrasound will confirm your diagnosis, but can also exclude other causes.
What else could it be?
Because your TA is so poorly supplied with blood, it is possible for parts of it to die off, leaving areas of focal degeneration. In this case, the onset of pain may be more insidious and you may notice a swollen area of tendon 1-2in long, tapering at each end. Surgery may well be required.
You can do a lot to both prevent and treat all minor TA problems. Prevention should include: 1 A Sorbothane-type heel raise, lessening the strain on the tendon and softening the landing forces; 2 Ensuring that the heel tabs on your shoes don’t press on your TA when your toes are pointed, and cutting them off horizontally if they do; 3 Using orthoses if you overpronate. Pronation twists and untwists the TA with every stride. To treat it use:
- RICE – particularly the ‘ice’ part, massaging the tendon with a cube upwards and downwards frequently;
- Stretching – even more frequently! Try facing a wall, placing your forearms against it, feet 1.5-2ft away and slightly turned in, then, with knees held straight, push your hips towards the wall and hold still with the TA feeling merely uncomfortable for 30 seconds. A little bending of your knees can alter the site of the stretch. Repeat again and again.
Although severe and recurrent partial TA ruptures may deserve surgery, operations leave scars, which also have to be rehabilitated, so doctors are increasingly reluctant to apply scalpel to skin. Some electronic treatments such as ultrasound put energy into your tendon, but as the blood supply is so poor, this can technically ‘fry’ it, so it must be used very carefully. Laser is preferable for physio use, but the majority of treatment shouldn’t be electrically based – rather add careful local massage to free scarred areas to the self-treatment outlined above.
Can you run through it?
Yes, but you’re probably foolish and simply worsening what can be a very long, drawn-out and chronic injury. Spend your time cycling instead. This will exercise your heart and stretch scar tissue more gently and regularly.
There is a high risk of reinjury if treatment is overenthusiastic, so length of recovery time is rather like that of the proverbial piece of string.