Got hit in the Achilles tendon? Here’s what injuries it can cause and how to treat them

A direct hit to your Achilles tendon does not always cause the same type of injury. In this article, we discuss three types of injury that may result from getting hit in the Achilles tendon, how to treat your Achilles tendon injury after a direct blow, and what factors may influence your healing. Remember, if you need more help with an Achilles injury, you're welcome to consult one of our team via video call.

Examples of getting hit in the Achilles tendon include being kicked during football/soccer or being hit with a hockey stick. Off the playing field, it could be something like someone shoving their shopping trolley against your Achilles tendon or when you step back quickly and knock your heel or ankle against something.

The terms tendinitis, tendonitis, tendinosis, and tendinopathy mean the same thing for all practical purposes, and we use these interchangeably in our articles.

In this article:

1. Achilles tears/ruptures

2. Achilles tendonitis or tendinopathy

3. Heel bursitis

4. How we can help

We've also made a video about it:

Achilles tears/ruptures

Getting hit on the Achilles tendon can cause a partial or full Achilles tendon tear. This is why it is always worth getting your tendon checked by a doctor or physiotherapist if you’ve taken a hard blow to it. Signs of a partial or full Achilles tendon tear include if the pain lasts for more than a day, if there’s swelling, or if you’ve lost some strength, i.e. you struggle to raise your heel from the floor while you’re standing.

How do you treat it?

We’ve written detailed articles about the diagnosis and treatment of partial Achilles tears and full Achilles ruptures. The most important factors that determine the success of your treatment when you have an Achilles tendon tear are how quickly you can get it diagnosed correctly and how quickly your foot can be immobilised in a boot or cast at the correct angle (toes pointing down into plantar flexion).

Achilles tendonitis or tendinopathy

A direct blow to your Achilles tendon can also cause an acute (or reactive) tendonitis/tendinopathy. The tendon becomes painful, and doing activities that put high loads through your Achilles, e.g. running or walking long distances, may cause it to hurt.

If the hit to your tendon was where its bottom end attaches into the heel bone, it may cause insertional tendonitis. If the hit was higher up, it will likely cause mid-portion Achilles tendonitis.

The research shows that this can then go either of two ways. This acute tendonitis can either calm down and go away within a few weeks, or it can turn into an ongoing tendinopathy, where the tendon structure changes.

Once the structure changes, it usually takes months of dedicated rehab for the tendon to recover. We don’t yet fully understand what factors cause it to turn into an ongoing tendinopathy, but whether you continue to irritate it or not after you’ve injured it would likely be a contributing factor.

How do you treat it?

You treat a tendonitis from a direct hit on the Achilles exactly the same as a regular tendonitis or tendinopathy that was caused by training overload:

1. Take good care of your injured tendon and allow the injury to calm down and recover. The best way to do this is by reducing all your activities to a level that does not cause your tendon to hurt. This is also known as relative rest, and we’ve explained how to apply relative rest in this article.

2. Avoid taking anti-inflammatory medication (NSAIDs) like ibuprofen, naproxen, or indomethacin, as they have been shown to interfere with normal tendon healing. If you want something to reduce the pain, check with your doctor whether paracetamol would be OK.

3. Avoid corticosteroid injections, as they too have been shown to have a negative impact on tendon healing.

4. Rebuild your tendon’s strength with exercises that start at a level that does not increase your pain and slowly increase in intensity as your injury recovers. The exercises you do for insertional Achilles tendonitis are a bit different (see here) from those you do for mid-potion Achilles tendonitis. A physiotherapist can assess your tendon and ensure that you’re doing the correct exercises for your injury.

Heel bursitis

If you got hit in the back of your heel, where the Achilles tendon attaches to the heel bone, it could cause a heel bursitis.

The bursa is a fluid-filled sac between your Achilles tendon and your heel bone. It reduces the friction between the tendon and the bone. When it gets knocked hard, it can become inflamed, swollen, and very painful. Sometimes it can be mistaken for insertional Achilles tendonitis, and other times you can have a double injury – bursitis as well as insertional Achilles tendonitis.

How to treat it

The best thing you can do to calm down an irritated or inflamed bursa quickly is to take the strain off it. You can do this by lifting your heel up a bit, e.g. by placing a heel lift in your shoe or wearing a shoe with a slightly raised heel. Just make sure that the shoe doesn’t press directly on the painful bursa, as that will irritate it further.

An irritated bursa can respond really well to anti-inflammatory medication, so speak to your doctor about that. A cortico-steroid injection might even be worth considering in cases where it doesn’t want to settle down, but you have to make sure that it is injected into the bursa and not into the tendon. We’ve discussed all the treatment options for heel bursitis in detail in this article.

How we can help

Need more help with your Achilles injury? You’re welcome to consult one of the team at TMA online via video call for an assessment of your injury and a tailored treatment plan.

We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Treat My Achilles we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.

About the Author

Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Master's Degree in Sports Injury Management. Follow her on LinkedIn or ResearchGate.

References:

1. Cook, J. L. and C. R. Purdam (2009). "Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy." British Journal of Sports Medicine 43(6): 409-416.

2. Garau, G., et al. (2008). "Traumatic patellar tendinopathy." Disability and Rehabilitation 30(20-22): 1616-1620.

3. Maffulli, N., et al. (2011). "Achilles tendon ruptures in elite athletes." Foot & Ankle International 32(1): 9-15.