Ask the Expert: Dr. Andrew Elliott, Orthopedic Surgeon, Answers Your Questions About Achilles Tendon Ruptures

by Dr. Andrew Elliott
Sitting woman banding her ankle on white background

Q1. I’m a runner and have heel pain that won’t go away. How does a doctor determine if it’s my Achilles?

An examination can usually determine if it is your Achilles or different problem that is the cause of your pain. Sometimes an MRI might be necessary if the exam is inconclusive.

Q2. I have Achilles tendonitis, but I’m concerned that it could become more serious. Am I at a higher risk for an Achilles rupture?

Tendonitis is a normal tendon that is inflamed and should not put you at a higher risk for an Achilles rupture. However, tendonosis involves some degeneration of the tendon that can be painful. Tendonosis may put you at a higher risk for rupture.

Q3. I’ve heard about paratenonitis and insertional tendonitis of the Achilles, can you explain the difference?

Paratenonitis is inflammation of the paratenon, the surrounding “tube” that the tendon glides in. Insertional tendonitis is where there is some degeneration of the fibers of the tendon where they attach to the heel. It can be painful and you may form some thickness in the tissues there. An X-ray may show some calcification or a bone spur.

Q4. I’m an active runner. Are there ways to prevent myself from rupturing my Achilles tendon?

Stretching before and after activity may help prevent an Achilles rupture. Also, many of the running shoes these days have a slightly more elevated heel, which can take strain off the tendon. Varying your workout and cross training may help avoid overuse syndromes that can lead to tendon problems. In some patients, fluoroquinolone antibiotic medications may be associated with raising the risk of tendonosis and ruptures, so if you can avoid taking these drugs that may also help.

Q5. What are my treatment options for a ruptured Achilles tendon?

Repairing the Achilles with open surgery (3-4 inch long incision) or minimally invasive (1 inch incision) are two ways that may fix the tendon. Depending on the type of rupture, and the time from rupture to treatment, using a specially designed boot may also allow the tendon to repair by itself.

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The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.


Lynne leimberg says:

I have calcification and a bone spur in my right heel. Is there anything that can be done besides surgery. They said the bone spur is sticking out on a 90 degree angle it hurts all the time, but the pain in the leg is gone.

HSS on the Move says:

Hi Lynne, thank you for reaching out. Dr. Mark Drakos, Orthopedic Surgeon, says: “Heel spurs are common and do not always necessarily cause pain. Often heel spurs are related to muscle and tendon tightness. As such, a daily calf stretching program may be helpful.” Before undergoing a new program, you should seek consultation with a physician so they can determine the best course of treatment. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

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