Achilles Tendinitis

Anatomy

The Achilles tendon is a strong, cord-like ligament that connects the muscles at the back of the calf to the calcaneus (heel bone).  It is the thickest and strongest tendon in the human body.

 

Types of Achilles Tendinitis

Achilles tendinitis is an inflammation of the Achilles tendon.  There are two types:

  • Noninsertional Achilles Tendinitis – fibers in the middle portion of the tendon have begun to degenerate, swell, and thicken.  This type usually affects younger, active people.
  • Insertional Achilles Tendinitis – occurs at the point where the tendon attaches to the heel bone, and can happen to anyone at any time.

 

In both types of Achilles tendinitis, the damaged tendon fibers may begin to calcify, or harden.  Bone spurs may form with insertional Achilles tendinitis.

Causes of Achilles Tendinitis

Typically no specific injury causes Achilles tendinitis, rather the problem results from repetitive stress to the tendon, which often occurs when people push themselves too fast.  Factors that can increase the risk of Achilles tendinitis include:

  • Bone spurs that form and rub against the tendon
  • Not warming up before exercise or other vigorous activity
  • Sudden increase in the amount or intensity of activity

Symptoms of Achilles Tendinitis

Common symptoms of Achilles tendinitis include:

  • Pain and stiffness along the tendon that increases with activity
  • Swelling that increases with activity
  • Bone spurs
  • Thickening of the tendon
  • Severe pain the day after physical activity

Diagnosis

Your doctor will discuss your symptoms and perform a physical examination, by testing your range of motion and looking for swelling or thickening along the tendon, bone spurs, and location of pain or tenderness.  X-rays may be ordered to show whether the tendon has calcified, and an MRI may be ordered to assess the severity.

 

Treatment Options for Achilles Tendinitis

Non-Surgical Treatment

Rest is generally the first step in non-surgical treatment.  Taking a break from activities that caused the pain is important.  Icing the most painful area for up to 20 minutes at a time several times a day will reduce swelling.  Anti-inflammatories can also be used to reduce pain and swelling.  Physical therapy may be recommended, and there are exercises you can do at home to help restore strength and motion, such as calf stretches and heel drops.

 

Certain shoes and orthotic devices such as heel lifts or Achilles sleeves may help with pain from insertional Achilles tendinitis. A walking boot may be recommended for a short time for severe cases.

Surgical Treatment

Surgery should only be considered if non-surgical treatment fails.  Depending on the location and amount of damage, there are different procedures that may be performed:

  • Gastrocnemius recession is a lengthening of the calf muscle that can help patients with tight calf muscles and difficulty flexing their feet.
  • Debridement (removal) and repair is an option if a limited portion of the tendon is damaged.  After the unhealthy portion of the tendon is removed, the remaining tendon is stitched together
  • Debridement with tendon transfer is done when most of the tendon needs to be removed.  This portion will be replaced with tissue from another tendon.

Surgical Complications

Complications of surgical treatment of Achilles tendinitis include:

  • Infection
  • Blood clots
  • Pain

Post-Surgical Rehabilitation

Physical therapy is the most important part of recovery.  Depending on the severity of the injury, it could take a year or more to become pain-free, and some patients may not be able to return to their previous level of sports.

If you have more questions, please call my office at 502-394-6341.