Achilles tendinitis is an overuse injury of the Achilles (uh-KIL-eez) tendon, the band of tissue that connects calf muscles at the back of the lower leg to your heel bone. Under too much stress, the tendon tightens and is forced to work too hard. This causes it to become inflamed (that?s Achilles tendinitis), and, over time, can produce a covering of scar tissue, which is less flexible than the tendon. If the inflamed Achilles continues to be stressed, it can tear or rupture. Achilles tendinitis most commonly occurs in runners who have suddenly increased the intensity or duration of their runs. It?s also common in middle-aged people who play sports, such as tennis or basketball, only on the weekends. Most cases of Achilles tendinitis can be treated with relatively simple, at-home care under your doctor?s supervision. Self-care strategies are usually necessary to prevent recurring episodes. More-serious cases of Achilles tendinitis can lead to tendon tears (ruptures) that may require surgical repair.
Some of the causes of Achilles tendonitis include, overuse injury – this occurs when the Achilles tendon is stressed until it develops small tears. Runners seem to be the most susceptible. People who play sports that involve jumping, such as basketball, are also at increased risk. Arthritis – Achilles tendonitis can be a part of generalised inflammatory arthritis, such as ankylosing spondylitis or psoriatic arthritis. In these conditions, both tendons can be affected. Foot problems – some people with flat feet or hyperpronated feet (feet that turn inward while walking) are prone to Achilles tendonitis. The flattened arch pulls on calf muscles and keeps the Achilles tendon under tight strain. This constant mechanical stress on the heel and tendon can cause inflammation, pain and swelling of the tendon. Being overweight can make the problem worse. Footwear – wearing shoes with minimal support while walking or running can increase the risk, as can wearing high heels. Overweight and obesity – being overweight places more strain on many parts of the body, including the Achilles tendon. Quinolone antibiotics – can in some instances be associated with inflammatory tenosynovitis and, if present, will often be bilateral (both Achilles), coming on soon after exposure to the drug.
There are several types of Achilles tendinitis symptoms, but all of them are closely related. People who suffer from Achilles tendon pain typically have swelling in the Achilles tendon, and that pain can be chronic as the microscopic tears in the area become more prevalent over time. The most intense pain is typically located just a few centimeters above the area where the tendon meets the heel. This area is called the watershed zone, and the amount of blood moving through it is what gives it the highest potential for injury, especially for athletes. Most of the Achilles tendinitis symptoms in people with the condition will happen immediately after they have been inactive for a fairly significant amount of time. That means that the most pain will generally be felt after sitting or lying down for an extended period, or right after waking up in the morning and getting moving. If you aren?t positive that you are suffering specifically from Achilles tendinitis symptoms, consult a doctor to make sure.
Physicians usually pinch your Achilles tendon with their fingers to test for swelling and pain. If the tendon itself is inflamed, your physician may be able to feel warmth and swelling around the tissue, or, in chronic cases, lumps of scar tissue. You will probably be asked to walk around the exam room so your physician can examine your stride. To check for complete rupture of the tendon, your physician may perform the Thompson test. Your physician squeezes your calf; if your Achilles is not torn, the foot will point downward. If your Achilles is torn, the foot will remain in the same position. Should your physician require a closer look, these imaging tests may be performed. X-rays taken from different angles may be used to rule out other problems, such as ankle fractures. MRI (magnetic resonance imaging) uses magnetic waves to create pictures of your ankle that let physicians more clearly look at the tendons surrounding your ankle joint.
The main treatments for Achilles tendinitis do not involve surgery. It is important to remember that it may take at least 2 to 3 months for the pain to go away. Try putting ice over the Achilles tendon for 15 to 20 minutes, two to three times per day. Remove the ice if the area gets numb. Changes in activity may help manage the symptoms. Decrease or stop any activity that causes you pain. Run or walk on smoother and softer surfaces. Switch to biking, swimming, or other activities that put less stress on the Achilles tendon. Your health care provider or physical therapist can show you stretching exercises for the Achilles tendon. They may also suggest the following changes in your footwear, a brace or boot or cast to keep the heel and tendon still and allow the swelling to go down, heel lifts placed in the shoe under the heel, shoes that are softer in the areas over and under the heel cushion. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen can help with pain or swelling. Talk with your health care provider. If these treatments do not improve symptoms, you may need surgery to remove inflamed tissue and abnormal areas of the tendon. Surgery also can be used to remove the bone spur that is irritating the tendon. Extracorporeal shock wave therapy (ESWT) may be an alternative to surgery for people who have not responded to other treatments. This treatment uses low-dose sound waves.
Around 1 in 4 people who have persisting pain due to Achilles tendinopathy has surgery to treat the condition. Most people have a good result from surgery and their pain is relieved. Surgery involves either of the following, removing nodules or adhesions (parts of the fibres of the tendon that have stuck together) that have developed within the damaged tendon. Making a lengthways cut in the tendon to help to stimulate and encourage tendon healing. Complications from surgery are not common but, if they do occur, can include problems with wound healing.
Do strengthening and stretching exercises to keep calf muscles strong and flexible. Keep your hamstring muscles flexible by stretching. Warm up and stretch adequately before participating in any sports. Always increase the intensity and duration of training gradually. Do not continue an exercise if you experience pain over the tendon. Wear properly fitted running and other sports shoes, including properly fitted arch supports if your feet roll inwards excessively (over-pronate).