Achilles tendonitis is a condition of irritation and inflammation of the large tendon in the back of the ankle. Achilles tendonitis is a common overuse injury that tends to occur in middle-age recreational athletes. The overuse causes inflammation that can lead to pain and swelling. Furthermore, Achilles tendonitis can lead to small tears within the tendon, and make it susceptible to rupture.
What causes Achilles tendonitis?
The two most common causes of Achilles tendonitis are:
- Lack of flexibility
Other factors associated with Achilles tendonitis are recent changes in footwear, and changes in exercise training schedules. Often long distance runners will have symptoms of Achilles tendonitis after increasing their mileage or increasing the amount of hill training they are doing. As people age, tendons, like other tissues in the body, become less flexible, more rigid, and more susceptible to injury. Therefore, middle-age recreational athletes are most susceptible to Achilles tendonitis.
What are the symptoms of Achilles tendonitis?
The main complaint associated with Achilles tendonitis is pain over the back of the heel. This is the point where the tendon inserts on the heel bone. Patients with Achilles tendonitis usually experience the most significant pain after periods of inactivity. Therefore patients tend to experience pain after first walking in the morning and when getting up after sitting for long periods of time.
Patients will also experience pain while participating in activities, such as when running or jumping. Achilles tendonitis pain associated with exercise is most significant when pushing off or jumping.
How is Achilles tendonitis diagnosed?
Diagnosis of Achilles tendonitis is accomplished by history and physical examination. The symptoms associated with this condition are typical and can be elicited by a thorough history. A physical examination is used to determine the location of the problem.
X-rays are usually normal in patients with Achilles tendonitis, but are performed to evaluate for other possible conditions. Occasionally a MRI is needed to evaluate a patient for tears within the tendon.
If there is a thought of surgical treatment a MRI may be helpful for preoperative evaluation and planning.
Tendinitis of the heel
Definition of Achilles tendinitis:
Achilles tendinitis is inflammation, irritation, and swelling of the Achilles tendon (the tendon that connects the muscles of the calf to the heel).
Causes, incidence, and risk factors:
There are two large muscles in the calf, the gastrocnemius, and soleus. These muscles generate the power for pushing off with the foot or going up on the toes. The large Achilles tendon connects these muscles to the heel.
These are important muscles for walking. This tendon can become inflamed, most commonly as a result of overuse or arthritis, although inflammation can also be associated with trauma and infection.
Tendinitis due to overuse is most common in younger individuals and can occur in walkers, runners, or other athletes, especially in sports like basketball that involve jumping. Jumping places a large amount of stress on the Achilles tendon.
Tendinitis from arthritis is more common in the middle aged and elderly population. Arthritis often causes extra bony growths around joints, and if this occurs around the heel where the Achilles tendon attaches to the heel bone, the tendon can become inflamed and painful.
Symptoms usually include pain in the heel when walking or running. The tendon is usually painful to touch and the skin over the tendon may be swollen and warm.
Achilles tendinitis may make you more likely to have an Achilles rupture. This condition usually causes a sharp pain, like someone hit you in the back of the heel with a stick.
Signs and tests:
On physical exam, a doctor will look for tenderness along the tendon and for pain in the area of the tendon when the patient stands on their toes. Imaging studies can also be helpful. X-rays can help diagnose arthritis and an MRI will demonstrate inflammation in the tendon.
Treatment for Achilles tendonitis is usually non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen, rest, ice, and physical therapy. In addition, you should limit any activities that make the symptoms worse.
Occasionally, a cast, brace, or boot may be used to keep the heel still and allow the swelling to go down. If these treatments fail to improve symptoms, surgery may be needed to remove inflamed tissue and abnormal areas of the tendon.
Conservative therapy is usually successful in improving symptoms, although they may recur if the offending activity is not limited or if the strength and flexibility of the tendon is not maintained.
When necessary, surgery has been shown to be very effective in improving pain symptoms. However, if pain does not improve with treatment and vigorous activity is continued, the tendon is at risk of completely tearing.
The worst complication is tearing of the tendon. This occurs because the inflamed tendon is abnormal and weak and continued activity can cause it to rupture. In this case surgical repair is necessary, but made more difficult because the tendon is not normal.
Calling your health care provider:
If you have pain in the heel around the Achilles tendon that is worse with activity, contact your health care provider for evaluation and possible treatment for tendinitis.
Prevention is very important in this disease. Maintaining strength and flexibility in the muscles of the calf will help reduce the risk of tendinitis. Overusing a weak or tight Achilles tendon is a set-up for tendinitis.