Causes and Risk Factors for Achilles Tendon Damage

Anyone can hurt their Achilles tendon, but some people are more prone than others. Factors that increase the likelihood of Achilles tendonitis and other tendon problems include

• A change in the athlete’s training schedule and/or intensity level, such as adding another few miles to a daily running routine or participating in plyometric exercises that require explosive movement, such as burpees or box jumps
• A change in playing surface, such as when a tennis player shifts from playing on grass courts to clay courts, or when the athlete changes footwear
• Tight or weak calf muscles can be overstretched, resulting in soft -tissue damage.
• Excessive pronation, defined as rolling inward on the foot when walking or running
• Chronic ankle instability, or a recurrent “giving way” or rolling of the ankle
• Leg-length discrepancy, even if quite small, can cause the body to compensate and put soft-tissue structures like the Achilles tendon at risk for injury
• Wearing high heels regularly can shorten the Achilles tendon, making it more prone to injury

• Excessive training, particularly running on hills, exposes the Achilles tendon to repeated micro-traumas that may add up to a symptomatic injury
• Increasing age (over 30 years of age) contributes to decreased blood supply to tendons, making them more prone to injury
• Use of fluoroquinolone antibiotics, such as ciprofloxacin (Cipro), gemifloxacin (Factive), or levofloxacin (Levaquin), puts a person at temporary risk of tendon injury¹Schepsis A.A., Jones H., and Haas A.L.: Achilles tendon disorders in athletes. Am J Sports Med 2002; 30: pp. 287-305
• High-arched feet are associated with a higher risk of developing Achilles tendinopathy
• Certain types of arthritis, such as ankylosing spondylitis or psoriatic arthritis, may also put a person at a greater risk of Achilles tendinopathy²Wright M, Tidy C. Achilles tendinopathy. Patient. Jan 2014. tp://www.patient.co.uk/health/achilles-tendinopathy. Accessed October 9, 2014.

Patients with one or more risk factors for Achilles injuries who experience recurrent pain or weakness at the back of the heel or ankle are advised to seek medical attention.

See The 2 Common Types of Heel Spurs

Acute injury risk
Achilles tendon tears or ruptures can result from a single hard athletic training session, a sudden push-off (i.e., when a track athlete starts a race), or a sudden change in direction.

Tears or ruptures to the Achilles tendon are most associated with acute injuries. But chronic tendinopathy can develop after multiple tears or acute inflammatory conditions fail to heal, which sometimes can occur when athletes are unwilling or unable to take adequate rest periods following injury.³Griffin M, Andrews J, Cole B, Maffulli N, Mandelbaum B, Rodeo S, Silvers H. Tendinopathy treatment tips. AAOS Now. October 2010. http://www.aaos.org/news/aaosnow/oct10/clinical1.asp . Accessed October 1, 2014.