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If you reach around behind your ankle and run your fingers from just above your heel bone to just below your calf muscle, you’ll feel a solid and very tight band of tissue known as the Achilles tendon. While it’s one of the strongest and biggest tendons in the human body, it can become overloaded, and Achilles tendon injuries, such as tears or tendinopathy, are common. When injuries do occur, these often lead to invasive surgery; however, surgery can be a problem. Why?

The Achilles tendon, despite the appearance of one thick tendon, is actually three subtendons twisted together to create one sold tendon. This makes surgical repair a particular challenge, especially considering most physicians only understand it as a single tendon. Let’s learn more.

The Achilles and Its Twisted Subtendons

The Achilles tendon experiences heavy use each and every day. Every time we take a step, the tendon is stretched and released over and over again. If you are an athlete or just an active person, your Achilles tendon is put under more extreme stress. These tendons along with their calf muscles also tend to become tight—what feels better than a gentle wall or stair stretch to lengthen out and soften these tight structures?

There are three calf muscles that the Achilles tendon supports. The lateral and medial gastrocnemius muscles are the two prominent muscles that define the shape of the calf. The soleus muscle runs behind the gastrocnemius muscles and continues down the leg behind the Achilles tendon. Each of the three muscles have specific functions, and each has different connecting points to the heel bone, which creates nonuniform degrees of pressure on the Achilles subtendons.

What this means is that instead of one large tendon having the strength to resist injury and absorb the stress load as a whole, it’s three smaller tendons receiving stress loads at varying degrees, making them more vulnerable to injury, and Achilles tendon injuries more common.

Surgery and the Achilles Tendon

Despite a study finding that surgery for an Achilles tear is no more effective than treating the tendon conservatively for a few weeks by bracing the ankle, invasive surgery is often the recommendation. Surgery involves repairing the torn tendon by sewing it back together. In addition to surgery likely being unnecessary in many cases, surgery comes with high complication rates and lengthy recoveries.

This doesn’t mean that if conservative measures fail that you should simply do nothing. In addition to further injuring the Achilles tendon, not addressing the injury can create instability not just in the ankle and tendon, but it can also cause pain and lead to arthritis in the knee. Why? Because the calf muscles that are supported by the Achilles tendon stretch all the way up the lower leg and attach behind the knee.

Additionally, if you are just experiencing pain, cramping, chronic tightness, or other similar symptoms in your Achilles tendon, this could potentially not be a problem in your tendon at all. The musculoskeletal system is all connected, and a nerve that has become irritated all the up in the lower back, can actually refer pain at any point along the nerve branch to the structures it supplies, even, yes, the Achilles tendon. To make it more complicated, you may or may not have pain in your back, so your doctor needs to understand how to investigate to find the root source of your problem.

Addressing Achilles Tendon Injuries Without Surgery

Knowing that the Achilles tendon is actually made up of a trio of subtendons, this makes surgery more complex as the rope-like subtendons, for proper repair, would need to be intricately realigned. Again, most surgeons only know to treat the Achilles tendon as one large tendon, so this kind of attention to alignment is unlikely to occur.

Precise guided injections of orthobiologics (e.g., your own PRP or stem cells) can be effective regenerative nonsurgical solutions for partial and even some complete Achilles tears as well as tendinitis and irritated nerves in the low back if that’s the real source of your Achilles issues.

Due to the intricate twisted structure of the Achilles subtendons, sewing a torn tendon back together is harder than once thought. Injections of orthobiologics, such as PRP, can stimulate your body to heal its own tendons.

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