Causes of Achilles Tendon Injury

Achilles tendon injuries can be caused by: overuse, misalignment, improper footwear, medication side effects, and/or accidents. Genetics can also be a factor. Multiple causes often contribute to the same Achilles tendon injury. For example: a sudden increase in hill climbing, worn out shoes, and weak or tight calf muscles could all contribute to Achilles tendinosis and Achilles tendonitis.

Overuse

Too fast of an increase in athletic activities such as:
-Running or walking longer;
-Running or walking faster;
-Running or walking up and down more or steeper hills or stairs;
-Running or walking up on a different surface (e.g. park vs. road);
-More or more powerful “explosive” movements such as lunges, jumps, or push off’s.

The athletic activity by itself is not the problem, the problem is doing too much too quickly or resuming too quickly after a layoff.

Types of injuries caused:
-Achilles tendinosis (also known as Achilles tendinopathy),
-Achilles tendonitis,
-Achilles tenosynovitis,
-Tennis Leg, or
-in the most severe cases: Achilles tendon rupture.

Misalignment

Examples:
-Unequal leg length,
-Over or under pronation,
-Short or tight Achilles tendons or calf muscles,
-Disproportionally weak calf muscles, and
-Misshapen heel or other foot bones.

Types of injuries caused:
-Achilles tendinosis (also known as Achilles tendinopathy), 
-Achilles tendonitis,
-Achilles tenosynovitis,
-Tennis Leg, or
-in the most severe cases: Achilles tendon rupture.

Improper Footwear

Examples:
Worn out shoes, and shoes or sports shoes with too much or too little:
-Arch support,
-Cushioning,
-Motion control,
-Heel support, and/or
-High height.

Types of injuries caused:
-Achilles tendinosis (also known as Achilles tendinopathy),
-Achilles tendonitis,
-Achilles tenosynovitis,
-Tennis Leg, or
-in the most severe cases: Achilles tendon rupture.

Medication Side Effects (Quinolone / Fluoroquinolone and Cortisone)

The Quinolone group of antibiotics
The quinolone group of antibiotics are used to treat a wide range of bacterial infections, but weaken some people’s tendons. The weakness is most often felt in the Achilles tendon because it is one of the largest and most heavily used tendons. The weakness may be felt as Achilles tendon soreness, or if it is severe enough, can lead to a rupture.

Fluoroquinolone is a commonly prescribed subset of the quinolone group, examples include: Ciprofloxacin (Cipro®, Cipro XR®, Baycip®, Cetraxal®, Ciflox®, Cifran®, Ciplox®, Cyprobay®, Proquin XR ®, Quintor®), Floxo®, Gemifloxacin (Factive®), Levofloxacin (Levaquin®), Moxifloxacin (Avelox®), Norfloxacin (Noroxin®), and Ofloxacin (Floxin®). In addition to treating bacterial infections, especially urinary infections, They are also used to treat Anthrax inhalation.

Type of injuries caused:
-Achilles tendinosis (also known as Achilles tendinopathy),
-Achilles tendonitis,
-Achilles tenosynovitis,
-Tennis Leg, or
-in the most severe cases: Achilles tendon rupture.

Cortisone

  • Cortisone is an indirect, rather than a direct, cause of Achilles tendon injury. Cortisone can make a weakened Achilles tendon feel too comfortable. A patient who has received cortisone shots in or near the Achilles tendon may be able to overly stretch or strain their Achilles tendon without any pain – until they stretch or strain it to the point of rupture
  • Contributing factor: the injury for which cortisone was prescribed.

Type of injury caused:
Achilles tendon rupture.

Accidents

Examples:
-Crushed in a car or work accident; or
-Cut (lacerated) by a lawn mower or in a work accident.

-Type of injuries caused:
-Crushed Achilles tendon, or
-Lacerated Achilles tendon.

Genetics

Individuals with the single nuclear polymorphism (SNP) TT genotype of the GDF5 rs143383 variant have twice the risk of developing Achilles tendon problems.

Type of injuries caused:
-Achilles tendinosis (also known as Achilles tendinopathy),
-Achilles tendonitis,
-Achilles tenosynovitis,
-Tennis Leg, or
-in the most severe cases: Achilles tendon rupture.

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