Achilles Tendon Injuries

The Achilles tendon is a strong band of tissue that attaches the calf muscle to the heel bone and plays an important role in a child’s ability to walk, run, jump, and stand on their toes.

An Achilles tendon injury is damage to this tendon, often related to sports that involve a lot of jumping, pivoting, and cutting.

There are different kinds of Achilles tendon injuries.

• Achilles tendonitis occurs when the tendon becomes inflamed and, in some cases, develops small tears as a result of repetitive strain on the tendon. Achilles tendonitis is most often an overuse injury that develops over time.
• An Achilles tendon rupture is a full or partial tear of the tendon that happens suddenly, often caused by concentrated stress or force. While many Achilles tendon ruptures happen during sports, they can also happen when a person falls from a height, trips, or misses a step.

• Pain down the back of the calf and around the heel
• Pain that increases with activity
• Trouble flexing the affected foot
• Stiffness and swelling of the lower calf

Achilles tendon ruptures have many of the same symptoms as Achilles tendonitis, however the injury and associated symptoms appear suddenly.

Additional symptoms include:

• Popping sound at the time of injury
• Intense pain in the calf and near the heel
• Inability to stand on the toes or push off the foot of the injured leg when walking

Achilles tendon injuries often occur during sports that involve a lot jumping, cutting, and pivoting: Basketball, soccer, gymnastics, figure skating, and track and field are a few examples.

The following factors increase an athlete’s risk of Achilles tendon injury:

• Playing on hard or uneven surfaces
• Playing in non-supportive shoes
• Overtraining without enough rest
• Sudden increase in training time or intensity
• Lack of proper stretching and conditioning

Your child’s doctor will examine your child’s leg and ask about their symptoms. They may ask when the pain started, how intense it is, what part of the calf is painful, and if the pain increases with activity.

Your child’s doctor may order an imaging test, such as an X-ray, ultrasound, or MRI, to look for signs of an Achilles tendon injury. These tests can also help determine how severe the injury is.

Your child’s treatment will depend on several factors, including the severity of their injury. Your child will need to take time off from sports and other activities so their Achilles tendon has time to heal. Their doctor will tell you how long they need to rest.

Other possible treatments include:

• Anti-inflammatory medication like ibuprofen for pain relief
• A cast or boot to hold your child’s calf and foot still
• Physical therapy to stretch and strengthen the muscles in the lower leg

If you child has a severe Achilles tendon injury, they may need surgery to repair the tendon. Most patients are able to go home on the same day they have surgery.

This too depends on the severity of the injury as well as your child’s age, activity level, and how well they adhere to physical therapy.

• A mild strain or partial tear can take up to three months to recover from.
• A complete rupture can take four to six months to recover from and up to a year before an athlete can return to their sport without restriction.

There are many ways athletes can reduce their risk of Achilles tendon injuries:

• Warm up before each practice or game
• Regularly stretch and strengthen the calf muscles
• At the start of a new season, or when starting a new activity, start slow and add intensity over time
• Always play in shoes with good cushioning and arch support
• Replace shoes that no longer provide support
• Avoid playing on uneven, hard, or slippery surfaces
• Pay attention to symptoms. If your child’s calf is painful, swollen, or tender, have them take time off and make an appointment with their doctor or a sports medicine specialist.

As the largest and most experienced pediatric and young adult sports medicine practice in the country, Boston Children's Sports Medicine Division provides athletes of all ages the care they need to reach their athletic potential.

The Micheli Center for Sports Injury Prevention, part of the Sports Medicine Division, is dedicated to the prevention of sports injuries. Our practical strategies help young athletes reduce their risk of injury while enhancing their sports performance. Our rehabilitation and strength training programs help injured athletes return to play stronger and healthier.