Achilles Tendinitis

The Achilles tendon, the largest and strongest tendon in the body, is a fibrous cord that connects the muscles in the back of your calf to your heel bone and helps control the foot when walking and running. The tendon is subject to a load stress two to four times body weight during normal walking and up to eight times body weight when running, therefore, regaining normal Achilles tendon function is critical.

Achilles tendinitis, a common overuse condition, is an inflammation of the Achilles tendon that causes pain along the back of the leg near the heel.

Overview

Achilles tendinitis is a common overuse injury that causes pain along the back of the leg near the heel. This condition is essentially an inflammation of the Achilles tendon which is a natural response the body has to injury and often causes pain, swelling, or irritation. Achilles tendinitis most commonly occurs in runners who suddenly increase the duration or intensity of their run - such as intense training before a major run, or middle-aged weekend warriors who play sports such as basketball or tennis, requiring them to jump or make swift changes in direction.

There are two types of Achilles tendinitis based on the location of the inflammation - Noninsertional Achilles Tendinitis and Insertional Achilles Tendinitis. Noninsertional Achilles Tendinitis occurs when fibers in the middle portion of the tendon began to degenerate, thicken, and swell up - this mostly affects younger, active individuals. Insertional Achilles Tendinitis on the other hand, occurs when the tendon attaches itself to the heel bone and can result in calcification or bone spurs (extra bone growth).

Symptoms

The pain associated with Achilles tendinitis generally begins was a mild ache either above the heel or the back of the leg after any sport-related activity. Most people experience the following symptoms:

  • Tenderness and stiffness along the Achilles tendon, especially in the morning
  • Mild or severe pain near the heel or along the Achilles tendon that worsens with activity
  • Mid or severe pain the day after exercising
  • Noticeable lumps or thickening of the Achilles tendon
  • Persistent swelling that worsens with activity
  • Bone spur

If there is persistent pain around the Achilles tendon or a "pop or snap" in the back of the calf or heel, consulting a physician immediately is highly recommended as an Achilles tendon rupture could be a likely cause.

Diagnosis

The diagnosis of an Achilles tendinitis is generally made on physical examination. The physician will examine the foot and ankle by gently pressing on the affected area to look for the symptoms mentioned above in addition to evaluating flexibility, range or motion, alignment, and reflexes. Furthermore, the physician may order an x-ray scan, ultrasound, or MRI scan to assess your condition and determine the proper course of treatment.

Treatment

Achilles tendinitis responds well to non-operative measures and this approach will provide pain relief, though it may take a few months (three - six) for symptoms to completely subside even with early treatment. However, in extreme cases if signs and symptoms are severe and persistent and more conservative treatments don't work, the physician may recommend an operative treatment option as a last resort.

Rest - It is advised to decrease or completely stop the activity that makes the pain worse. A great way to stay active while allowing the symptoms to subside is to switch to low-impact, cross-training activities such as biking, elliptical machines, or swimming.

Ice - Placing ice on the most painful areas of the Achilles tendon throughout the day for up to 30 minutes (less if the skin becomes numb) for each application can greatly soothe the pain.

Medication - Over-the-counter medication such as ibuprofen and naproxen usually help reduce pain and swelling. If these are deemed insufficient by your physician, they might prescribe stronger medication to relive pain and reduce inflammation. These medications will reduce pain, but will not reduce the thickness of the degeneration of the tendon.

Physical Therapy - Physical Therapists will often prescribe specific strengthening and stretching exercises that promote healing and strengthening of the Achilles tendon. They might even recommend orthotic devices such as a shoe insert or a wedge that elevates the heel to relieve pressure and strain on the tendon and provide cushion. If your pain is severe, your physician may recommend a walking boot for a short time.

Surgery - Surgery should only be considered if the pain does not improve after six months of nonsurgical treatments. The specific type of surgery depends on the severity of the damage as well as the location of the tendinitis and should be discussed with the physician when the need is identified.

Recovery

Regardless of the treatment approach taken, patients go through a rehabilitation program which includes physical therapy exercises that are crucial to strengthen your leg muscle and Achilles tendon. Each patient is unique, so the therapy program will vary based on his/her level of pain, extent of injury, and desired level of activity. Most patients require up to 12 months of rehabilitation before they can return to the prior activity level.

Disclaimer

CALL 911 IMMEDIATELY IF YOU ARE HAVING A MEDICAL EMERGENCY!

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