What is Achilles Tendonitis?

The Achilles tendon, which connects the calf muscles to the heel bone (calcaneus), is a thick band of fibrous tissue. It is the largest tendon in the body and enables such activities as walking, running, jumping and climbing up stairs.

Achilles tendonitis is an inflammation of the tendon. Inflammation is the body’s response to injury or disease and triggers characteristic symptoms. Although the Achilles tendon can withstand significant stress, such as from running or jumping, it can also be the site of an acute or chronic injury that causes pain in the heel.

Achilles tendonitis is particularly common in runners, middle-aged athletes and athletes with tight calf muscles. The running motion lends itself to this injury, as the Achilles tendon is what generates the force from pushing off the ground on each step. That force can be as much as three times a runner’s body weight.

Achilles Tendonitis Symptoms 

Symptoms of Achilles tendonitis include:

• Pain and stiffness of the tendon, particularly in the morning or with movement
• Pain, swelling and thickening where the tendon attaches to the back of the heel bone
• Pain with direct pressure from shoes
• Tenderness
• Pain that may disappear after warming up during exercise
• Increase in pain following exercise

Achilles Tendonitis Causes and Risk Factors

There are a variety of possible contributing factors, but arguably the most common is a sudden increase in exercise volume or overuse syndrome among athletes. The Achilles tendon is also vulnerable to injury because of the stress it endures, especially from explosive movements like jumping. The limited blood supply to the area makes Achilles tendonitis difficult to heal on its own.

Common causes and risk factors include:

• Gender (Achilles tendonitis is more common in men)
• Aging (incidence increases with age)
• Tight calf muscles
• Weakness of the lower legs
• A sudden increase in amount or intensity of exercise or sports
• Improper warmup before exercise
• Improper shoes, lacking support, or worn out shoes
• Running/exercise surfaces (concrete, hilly terrain, uneven surfaces)
• Bone spurs (revealed by X-ray) at the insertion of the Achilles tendon
• Conditions that put increased pressure on the Achilles, such as:
• Overweight/obesity
• Flat feet
• Overpronation (feet roll inwards)

Diagnosing Achilles Tendonitis

Following a review of the patient’s symptoms and medical history, the healthcare provider performs a physical examination. The doctor checks for swelling, tenderness and pain along the tendon, and palpates the area to pinpoint the exact location of the most severe pain and swelling.

Diagnostic imaging tests to confirm Achilles tendonitis can include:

• X-rays to look for bone problems (e.g. bone spurs)
• MRI to determine an Achilles tendon tear
• Ultrasound, a possibility to explore damage that is revealed by viewing the movement of the tendon

Achilles Tendonitis Treatment

The choice of treatment for Achilles tendonitis depends on the individual and the severity of the condition. While initial treatment can be done independently, those with severe pain that disrupts normal functioning should see a doctor. A doctor should be seen immediately if there is a popping or snapping sound in the ankle area.

Initial treatment includes:

R.I.C.E., which stands for:

• Rest-This can mean anything from reducing the intensity of workouts to completely ceasing activity or exercise that exacerbates the problem.
• Ice-Applying ice to the affected area, especially after exercise, can help to reduce inflammation and pain.
• Compression-Athletic tape wrap or an ankle compression brace (ankle sleeve) can help reduce inflammation and provide support.
• Elevation-Elevating the foot above the heart level can also help to keep the swelling down.

Medication – Over the counter NSAIDs (Nonsteroidal anti-inflammatory drugs), which are used to treat inflammation. Examples include ibuprofen and naproxen.

Physical therapy (PT)- PT for Achilles tendonitis focuses on eccentric strengthening of the Achilles tendon and the calf muscles. PT can also include flexibility and strengthening exercises. Other PT modalities used may include deep tissue massage.

Shoe wear – Changing the types of shoes or adding the use of heel pads (orthotics).

Most Achilles tendonitis is treated successfully with non-operative methods. Many providers avoid cortisone injections due to the risk of Achilles tendon rupture.

For those who fail the first line of treatment, surgery can improve Achilles tendonitis symptoms. Surgery is not usually considered unless the patient has tried nonsurgical treatment methods without success. Surgery to treat Achilles tendonitis can include:

• Tendon debridement – Removal of damaged tissue
• Tendon augmentation – Grafted tissue used to strengthen a damaged tendon and help it to heal
• Tendon transfer – Damaged tendon replaced with a healthy tendon

A limited blood supply to the area means slow healing for Achilles tendonitis. Healing without surgery may take three to six months. Recovery time from surgery can vary depending on the surgery and the extent of the damage, but can take up to a year to fully recover from.

If you are troubled by pain in the back of your ankle or calf, request an appointment at University Orthopaedic Associates. Our foot and ankle or sports medicine experts can determine if you have Achilles tendonitis or another condition, and come up with a treatment plan that can help get you out of pain and back to your activities.