Orthopedist Questions Orthopedist

Achilles tendon pain and snapping?

Several years ago I had injured my Achilles tendon/heel but did not require surgery since it was not completely ruptured. After several weeks of wearing a soft boot, the pain did subside and seemed to heal. However, more recently I have had pain in the area where the same area, where the tendon is attached to the heel. I wore the boot for about a week and can now walk without discomfort. However, I do hear and feel a snapping when walking. It was recently diagnosed as bursitis, but the snapping is a concern. What would cause the snapping in the tendon?

Male | 71 years old
Medications: Anti-inflammatory Gel
Conditions: None

5 Answers

Most commonly, achilles tendonitis or tear in my experience has been as a result of gout, uric acid more than 6.0, or combined with hypothyroidism (normal TSH is between 0.3-2.0 in most).
The main concern is pain. If you have continued pain with activities, you need to be evaluated by a specialist and consider obtaining MRI study or ultrasound study to further evaluate the tendon. The snapping if it is not painful should not be of concern. Many times there are snapping or popping or clicking but we cannot find the source and sometimes you can spend a lot of money doing multiple tests without results. But if the snapping itself causes pain then a detailed examination by a specialist as well as MRI study will be helpful.
There are several reasons for snapping in the calf after an Achilles’ tendon tear. These include scar tissue that did not organize normally leaving small nodules, bursa in front of and behind the tendon, calcium deposits(form after the tear) in or around the heal at the insertion. I would suggest initially as you did to place the boot until pain resolves and then hamstring and Achilles stretching several times a day for a couple of minutes particularly after sitting and before exercises. Also use voltaren gel or bio freeze several times daily with light Achilles massage. Finally a foam roller used on the calf muscles and hamstrings may be helpful. If all this fails after 3-6 weeks have a visit with your physician. Good luck and have a safe, happy New Year.
It is most likely scar tissue that has formed around the achilles tendon as part of the healing process. If the snapping is not painful, don't worry about it.

Hope it helps!!

Dr. Bose
Radiological studies may be helpful in determining the cause. X-rays and/or CT scan can look for calcium deposits, os trigonum (an accessory bone in the back of the ankle), and bone spurs, as well as fracture fragments and bone chips. An ultrasound is a dynamic test that can show which tendon is actually snapping and why, as well as show the bursitis. For instance, the peroneal tendons can snap and they are not far from your Achilles’ tendon. An MRI scan can show the tendons best and degenerative areas as well as ligaments, bursae and other soft tissue structures, some which can contribute to snapping. Talk to your orthopedic doctor to help decide which test(s) are necessary.

Ron Noy, MD