Sudden, sharp calf pain

The Achilles tendon is the strong tendon that joins our calf muscles to the heel bone.

The Achilles tendon is the strong tendon that joins our calf muscles to the heel bone.

A sudden sharp feeling of being kicked in the back of the lower leg is a tell tale sign of an Achilles Tendon rupture.

An Achilles tear occurs during a jumping action or when accelerating to commence sprinting. Both actions naturally involve sudden forceful heel raising movement called plantarflexion where huge tension is placed upon the Achilles tendon. The tendon has an area of poor blood supply which is susceptible to degenerative changes. Hence sudden jumping or acceleration movements expose these degenerative weaknesses causing a tear to the Achilles tendon.

The degenerative aspect of the Achilles tendon which can manifest itself in the form of tendinitis is often caused by excessive falling inwards (pronation) of the feet which can be seen in a patient with flat feet. The falling inward posture of the foot leads to abnormal tensile stress on the inner aspect of the Achilles tendon. In addition chronically tight calf muscles can cause reduced inward bending movement of the ankle joint (dorsiflexion) leading to increased pronation of the foot to compensate for this loss of movement. Furthermore poor warm-up prior to training or sports such as GAA, racquetball etc. can lead to Achilles tendon tears.

Signs & Symptoms

An audible pop noise is often heard with a feeling that you have been kicked in the back of the leg

Despite having pain, the patient will continue to be able to bend the ankle outwards due to the help of the Tibialis posterior and Peroneal muscles which sit in close proximity to the calf muscles.

Treatment & Management

In order to return to previous levels of activity after an Achilles tendon rupture, surgical repair is recommended in many cases. After surgery the foot is immobilised in a splint or cast for a period of 6-8 weeks. This period of inactivity and restriction results in maximum muscle wastage and joint stiffness. To counteract this and improve the rehabilitation process improved results can be achieved by placing the ankle in a splint that allows controlled ankle movement during the initial 6-8 weeks post surgery. This is then followed by progressive strengthening exercise programme as outlined by your physical therapist.

The return to sport is approximately six months post surgery, with the physical therapist confirming that all protocol testing has been successfully attained by the patient.

Tomás Ryan is a registered physical therapist with the Irish Association of Physical Therapy and is based in Clonmel & Thurles. Contact 0504 26672 or email tomaspryan@gmail.com