Achilles tendon: tendinopathy & rupture

On a step, lower slowly into the heel, come back up with the healthy leg. Twice daily fifteen repetitions over twelve weeks — the best-studied treatment of all, and it may pull a little.

Tendons have little blood supply and heal slowly. Three to six months are normal. Anyone who stops after two weeks because it still hurts starts from the beginning again and again.

One to two centimetres in both shoes noticeably relieve the tendon in everyday life — on both sides, so the pelvis stays level. It is a bridge for a few weeks, not a permanent state.

A sudden blow to the calf when pushing off, and afterwards no standing on the toes on that leg: that is a rupture and belongs looked at the same day. Walking is often still possible — that deceives.

One group of antibiotics can encourage tendon complaints and, rarely, a rupture, especially together with cortisone and at an older age. New tendon pain under them belongs reported.

A shortened calf muscle pulls on the tendon permanently. Stretching does not replace the training but makes it more bearable — and after sport it helps against the start-up pain the next morning.

An irritated Achilles tendon needs twelve weeks of eccentric training to improve measurably — that is the period the studies use, and the most common reason for failure is stopping after four to six weeks. Tendons turn over their tissue far more slowly than muscle. After a rupture, full load capacity takes six to twelve months, whether operated or not; the re-rupture rate is somewhat higher without surgery.

Anti-inflammatories help for days in the acute irritated state — in the longer-standing tendon change there is hardly any inflammation but a remodelling of the tissue, and there they do not work. Cortisone directly at the Achilles tendon is avoided, because the rupture risk rises. What remodels the tissue is load in the right dose: eccentric training, twelve weeks, twice a day — mild pain during the exercise belongs to it.

The tendon is stiff and painful after getting up, briefly improves with walking and gets worse again after the load. A thickening a few centimetres above the heel can be felt.

On rupture: a sudden blow or crack in the calf, often with the feeling that someone kicked from behind. Afterwards standing on tiptoe is impossible — that is the decisive test.

With a complete rupture a dent can be felt along the tendon. Walking is often still possible because other muscles step in — which deceives and makes some people come only days later.

A sudden rise in volume or pace, new shoes, hard ground, cortisone near the tendon, certain antibiotics of the quinolone group, high cholesterol and diabetes.

A raised sugar changes tendon tissue and lengthens the healing. With stubborn courses the value belongs alongside.

A thickened Achilles tendon with a very high cholesterol can point to an inherited disorder of fat metabolism — a rare but consequential chance finding.

Belongs alongside when the pain comes in attacks with redness instead of increasing with load.

Without vitamin D only a fraction of the calcium from food is taken up. It is the value that is most often too low with bone and joint complaints.

The building material itself. Better from food than from a tin: hard cheese, yoghurt, calcium-rich mineral water, almonds, broccoli and fortified plant drinks.

Activates the proteins that build calcium into bone. Green leafy vegetables and fermented foods cover it — under coumarin blood thinning the amount stays steady rather than swinging.

Bone is a third protein scaffold, and the muscles that hold it need protein too. In older people too little protein is more common than too little calcium.

Needed for building calcium in and for vitamin D to work. A lack slows both — even when calcium and vitamin D are supplied in sufficient amounts.

In small studies 10–15 g an hour before the targeted training, with vitamin C. The core of the treatment stays the eccentric loading over 12 weeks — the supplement is at best an addition.

Without vitamin C the body cannot cross-link stable collagen. 50 mg together with the collagen is the amount used in the studies — more brings nothing here.

Clearly worthwhile and well studied when deficient; fewer data for the wider uses. Fat-soluble — check blood levels at high doses.

Effective when deficient; effects on sleep and stress plausible but moderate. Too much causes loose stool.

Tendon tissue has receptors for this hormone; around menopause tendon complaints increase markedly. In pregnancy and in the weeks after birth the tissue is additionally softer — both belong in the picture when something suddenly tears.

Cortisone directly into the Achilles tendon is one of the few things clearly not done here — it raises the risk of rupture. Certain quinolone antibiotics do the same, especially together with cortisone.

The tendon heals through slow remodelling, and that needs pull. This is why eccentric training over 12 weeks is the treatment with the best numbers — rest alone does not heal a tendon.

Collagen needs vitamin C to cross-link. Small studies give 15 g gelatine or collagen with 50 mg vitamin C about an hour before loading; the evidence is young and thin.

Eccentric training is the best-evidenced treatment for Achilles tendon irritation. Studied at 3×15 repetitions twice daily over 12 weeks — it hurts at first and works nonetheless.

Small studies give 15 g collagen with vitamin C about an hour before the exercise. The evidence is young; the eccentric training remains the main thing.