Achilles tendinitis

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at April 26, 2016
StartDiseasesAchilles tendinitis

The Achilles tendon is a long band of tissue stretching from the heel to the calf. Overuse can cause this tissue to become inflamed and painful, a condition called Achilles tendinitis. While most cases of Achilles tendinitis can be treated with self-care strategies, the condition can lead to more serious injuries, such as tendon tears, that may require surgery.

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Definition & Facts

Achilles tendinitis is most often seen in runners who may have recently increased the intensity and duration of their workout. It is also common among “weekend warriors” who only play sports, such as basketball or tennis, on the weekends.

Achilles tendinitis can be classified according to which part of the tendon is affected. Non-insertional tendinitis occurs in the middle portion of the tendon and is most common among young, active individuals. Insertional tendinitis affects the lower part of the tendon where it attaches to the heel.

Both forms of tendinitis are the result of tiny tears that cause a breakdown of the tendon fibers. Over time, these fibers can calcify or harden. It is also common to see bone spurs form with insertional tendinitis.

Symptoms & Complaints

The symptoms of Achilles tendinitis may be acute or chronic. Acute symptoms typically include pain or stiffness behind the ankle and along the heel. In most cases, the onset of pain is gradual and develops over several days. The pain and stiffness are often worse first thing in the morning or when starting a workout. The pain may disappear once the tendon warms up but reappears after a period of rest or prolonged sitting.

The area from the heel to the calf may be tender to the touch, and there may be a visible lump or nodule at the site of the injury. The symptoms of Achilles tendinitis can become chronic if the condition is not treated or if the individual continues to overuse the tendon. Individuals should seek immediate medical attention if they experience sudden Achilles pain accompanied by a “popping” noise or have difficulty flexing and extending the foot. These symptoms may indicate a partial or complete tear of the tendon requiring surgical repair.

Causes

Achilles tendinitis is the result of repetitive strain and stress on the tendon. The structure of the tendon can deteriorate with age, making it more prone to injury from overuse, especially in individuals who only participate in sports on a limited basis or who suddenly intensify their workout regimen. Other factors can also increase the likelihood of an Achilles injury, including:

  • Foot mechanics—Individuals with flat feet or feet that tend to turn inward are at higher risk for tendinitis.
  • Incorrect footwear—Shoes that are worn out or that do not provide adequate arch support can increase the strain on the Achilles tendon.
  • High heels—Wearing high heels on a regular basis can cause the Achilles tendon to shorten. When the individual then wears running or other flat shoes, the tendon is stretched, which can cause strain and inflammation.
  • Sudden overuse—Individuals should avoid stepping up physical activity too quickly.
  • Running surface—Running on soft surfaces, uphill, or on a treadmill can stretch and injure the tendon.

Diagnosis and Tests

During a physical examination, the doctor will palpate or press around the heel and calf to determine the exact location of the pain. The physician will also assess the range of motion, flexibility, alignment, and reflexes in the foot and ankle. A variety of imaging tests may also be used to assess for soft tissue damage and rule out other conditions.

Ultrasounds use sound waves to evaluate the structure of the tendon, how it performs in action, and to assess blood flow in and around the tendon. MRIs can create detailed images of the Achilles tendon by using a combination of strong magnets and radio waves. MRIs are useful in determining the severity of tendon damage and if surgery is necessary.

X-rays do not provide images of soft tissue; however, they can provide clear images of bones, which can be beneficial in ruling out other types of injuries. X-rays can also show if any areas of the tendon have become hardened or calcified.

Treatment & Therapy

Conservative non-surgical therapies are typically used to treat Achilles tendinitis; however, it can take anywhere from three to six months for full recovery. The first treatment step is to rest and refrain from high-impact activities, such as running, that can exacerbate the pain. Ice therapy can help reduce pain and inflammation. The ice should be applied to the affected area for 10 to 20 minutes several times a day. Naproxen, ibuprofen, and other over-the-counter anti-inflammatories can be used on a temporary basis to reduce pain and swelling.

Physical therapy involving stretching and eccentric training can strengthen and lengthen the Achilles tendon to prevent further strain. Taping can help relieve Achilles pain by reducing the load on the tendon. Over-the-counter or prescription orthotics can correct over-pronation or misalignment of the ankle or foot that may be causing strain on the Achilles tendon. If the pain is especially severe, the doctor may recommend a walking boot; however, boots should only be used for a short time to avoid weakening the calf muscle. Surgery is normally only considered if the tendinitis is not relieved after six months of conservative therapy.

Prevention & Prophylaxis

The following measures can reduce the risk of various Achilles tendon injuries:

  • Wear good shoes. A quality pair of shoes will provide cushioning and firm arch support. Avid runners should replace their shoes at least once every three months.
  • Stretch and warm up. This will increase blood flow to muscles and other tissues and improve flexibility that can reduce the likelihood of injury.
  • Cross-train. It is a good idea to alternate high-impact activities, such as running, with low-impact workouts to avoid excess stress on tendons and muscles.
  • Don’t overdo it. It is best to increase the duration and intensity of a workout gradually. For example, runners should not increase their weekly distance by more than 10 percent a week.