Common Foot and Ankle Problems & Treatments
Achilles Tendonitis

General Information

Achilles tendonitis is an inflammation of the tendon from acute overuse.  Achilles tendonosis is a degeneration of the tendon from chronic overuse.   Increasing blood flow to the tendon is essential to helping to improve in the overall quality of the tendon.  

The Achilles tendon is the largest tendon in the human body. It can withstand forces of 1,000 pounds of for or more. It is a major accelerator needed when walking and running.  Because the Achilles is so exposed, the tendon often remains cooler that other tendons.  This in turn further limits the blood flow and decreases the elasticity of the tendon, setting tendon up for an acute or chronic injury. Tightness of the calf and Achilles, other biomechanical factors and poor choices of shoes can contribute to these injuries.

What are the symptoms?

  • Recurring localized pain, sometimes severe, along the tendon, or back of the heel bone during or a few hours after weightbearing activities.
  • Morning tenderness and stiffness in the achilles tendon.
  • Mild or moderate swelling in the achilles tendon or at its insertion.

Midsubstance Achilles Tendon Injury.

The area directly between the calf muscles and heel bone is known as the watershed region and the poorest blood supply.  This sets up the tendon for injury.

Insertional Achilles Tendon Injury

Here we often see a bony enlargement (heel spur) from chronic pulling of the tendon on the heel bone. This can cause fraying and intrasubstance tears of the tendon.  We may also see bursitis (inflammation of a natural cushion around the tendon).

 

Some events that can cause Achilles tendinitis:

  • Hill running or stair climbing.
  • Overuse resulting from the natural lack of flexibility in the calf muscles.
  • Rapidly increasing mileage or speed.
  • Starting up too quickly after a layoff.
  • Trauma caused by sudden and/or hard contraction of the calf muscles when putting out extra effort such as in a final sprint.

Achilles tendinitis often begins with mild pain after exercise or running that gradually worsens.

 

Diagnosis

Made by physical exam.

Often an MRI or sonogram is needed for proper diagnosis.

Treatment

Treatment for Achilles tendinitis (aka tendonitis)

Treatment normally includes:

  • A bandage, designed specifically to restrict motion of the tendon.
  • Non-steroidal anti-inflammatory medication.
  • Orthoses (devices to help to support the muscle and relieve stress on the tendon, such as a heel pad or shoe insert.
  • Rest, and switching to an exercise, such as swimming, that does not stress the tendon.
  • Stretching, massage, ultrasound and appropriate exercises to strengthen the weak muscle group in front of the leg and the upper foot flexors.

In extreme cases, surgery is performed, to remove fibrous tissue and repair any tears.