The Achilles tendon is the largest and strongest tendon in the body, formed by the convergence of the gastrocnemius and soleus tendons, inserting onto the middle third of the posterior calcaneal surface. It transmits the powerful plantarflexion force of the triceps surae and bears loads of 6-8 times body weight during running. The tendon spirals 90 degrees as it descends, with gastrocnemius fibres rotating to insert laterally and soleus medially.
| Muscle |
|
|---|---|
| Attachment | Middle third of the posterior surface of the calcaneus |
Transmits triceps surae force for ankle plantarflexion and push-off in walking, running and jumping
The Achilles tendon has a zone of poor vascularity 2-6 cm proximal to its calcaneal insertion, the most common site for degenerative mid-portion tendinopathy and spontaneous rupture. Mid-portion tendinopathy presents with morning stiffness, activity-related pain and focal tenderness, and responds to progressive loading such as the Alfredson eccentric heel-drop protocol. Insertional tendinopathy, often with Haglund deformity and retrocalcaneal bursitis, is aggravated by heel drops below neutral, so loading is kept out of dorsiflexion and shockwave therapy may help. Calf capacity is commonly judged by single-leg heel raises, with about 25 repetitions often used as a normal benchmark. Acute rupture produces a palpable gap, positive Thompson (Simmonds) test, and inability to single-leg heel raise, and conservative management in a functional boot competes with surgical repair for outcomes. Chronic rupture requires reconstruction with FHL transfer or V-Y tendon advancement.
Degenerative mid-portion changes from overloading, producing morning stiffness and activity-related pain, managed with progressive loading over 12+ weeks.
Degeneration at the calcaneal insertion, often with Haglund deformity, retrocalcaneal bursitis and intratendinous calcification, managed with loading that avoids deep dorsiflexion, shockwave therapy, and surgical debridement for refractory cases.
Complete failure 2-6 cm proximal to insertion producing a pop, inability to plantarflex against gravity, and positive Thompson test.
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