The Achilles tendon connects the calf muscle to the back of the heel. Injuries to the Achilles tendon are common, as it is in constant use during walking and running. These injuries, known as Achilles tendinitis, are usually the result of overuse damage and minor tears that have accumulated over years. Your risk of developing Achilles tendinitis increases with age and activity level. Many athletes develop Achilles tendinitis. The tendon may be injured several inches away from where it attaches to the foot or at the point of attachment. An injury at the point of attachment is called Achilles enthesopathy. We recommend a combination of treatments over a period of months that may include wearing supportive shoes or orthotic devices, performing stretching exercises, and icing the affected area. If these treatments are not effective, or if the tendon is completely torn, we may recommend surgery.
When you place a large amount of stress on your Achilles tendon too quickly, it can become inflamed from tiny tears that occur during the activity. Achilles tendonitis is often a result of overtraining, or doing too much too soon. Excessive hill running can contribute to it. Flattening of the arch of your foot can place you at increased risk of developing Achilles tendonitis because of the extra stress placed on your Achilles tendon when walking or running.
Symptoms include pain in the heel and along the tendon when walking or running. The area may feel painful and stiff in the morning. The tendon may be painful to touch or move. The area may be swollen and warm. You may have trouble standing up on one toe.
Examination of the achilles tendon is inspection for muscle atrophy, swelling, asymmetry, joint effusions and erythema. Atrophy is an important clue to the duration of the tendinopathy and it is often present with chronic conditions. Swelling, asymmetry and erythema in pathologic tendons are often observed in the examination. Joint effusions are uncommon with tendinopathy and suggest the possibility of intra-articular pathology. Range of motion testing, strength and flexibility are often limited on the side of the tendinopathy. Palpation tends to elicit well-localized tenderness that is similar in quality and location to the pain experienced during activity. Physical examinations of the Achilles tendon often reveals palpable nodules and thickening. Anatomic deformities, such as forefoot and heel varus and excessive pes planus or foot pronation, should receive special attention. These anatomic deformities are often associated with this problem. In case extra research is wanted, an echography is the first choice of examination when there is a suspicion of tendinosis. Imaging studies are not necessary to diagnose achilles tendonitis, but may be useful with differential diagnosis. Ultrasound is the imaging modality of first choice as it provides a clear indication of tendon width, changes of water content within the tendon and collagen integrity, as well as bursal swelling. MRI may be indicated if diagnosis is unclear or symptoms are atypical. MRI may show increased signal within the Achilles.
Achilles tendinitis can typically be treated at home by following the R.I.C.E. treatment method. Rest. Rest the tendon by avoiding activities that irritate the tendon or increase swelling. However, this does not mean you should be completely inactive for long periods of time, as this can cause stiffness in your joints. It?s still important to stretch in order to maintain strength and flexibility and partake in activities that don?t put direct pressure on the tendon, such as bicycling. Ice. Apply ice to the affected area for 20-minutes at a time, every couple hours, as needed, to reduce swelling and pain. Compression. Use compression bandages to help reduce swelling. Elevation. Elevate your ankle above the level of your heart to help reduce swelling. It is particularly important to do this at night while you sleep. Simply place a pillow or two under your ankle to keep it elevated. Once the tendon has healed, be sure to gradually return to more strenuous activities. If flattened arches contributed to the injury, wear shoes with appropriate support or inserts to prevent the condition from progressing or recurring. If these non-surgical treatments have not been able to provide relief of symptoms after several months, surgery may be performed to remove inflamed tissue. However, this is not usually recommended unless all other options have been exhausted. Consult your doctor for more information about surgical treatment options.
The type of surgery you will have depends on the type of injury you are faced with. The longer you have waited to have surgery will also be a factor that determines what type of surgery is needed. With acute (recent) tearing the separation in your Achilles tendon is likely to be very minimal. If you have an acute tear you may qualify for less invasive surgery (such as a mini-open procedure). Surgeons will always choose a shorter, less invasive procedure if it is possible to do so. Most surgeons know that a less complicated procedure will have less trauma to the tendon and a much quicker rate of recovery after the surgery.
To lower your risk of Achilles tendonitis, stretch your calf muscles. Stretching at the beginning of each day will improve your agility and make you less prone to injury. You should also try to stretch both before and after workouts. To stretch your Achilles, stand with a straight leg, and lean forward as you keep your heel on the ground. If this is painful, be sure to check with a doctor. It is always a good idea to talk to your doctor before starting a new exercise routine. Whenever you begin a new fitness regimen, it is a good idea to set incremental goals. Gradually intensifying your physical activity is less likely to cause injury. Limiting sudden movements that jolt the heels and calves also helps to reduce the risk of Achilles tendonitis. Try combining both high- and low-impact exercises in your workouts to reduce stress on the tendon. For example, playing basketball can be combined with swimming. It doesn?t matter if you?re walking, running, or just hanging out. To decrease pressure on your calves and Achilles tendon, it?s important to always wear the right shoes. That means choosing shoes with proper cushioning and arch support. If you?ve worn a pair of shoes for a long time, consider replacing them or using arch supports. Some women feel pain in the Achilles tendon when switching from high heels to flats. Daily wearing of high heels can both tighten and shorten the Achilles tendon. Wearing flats causes additional bending in the foot. This can be painful for the high-heel wearer who is not accustomed to the resulting flexion. One effective strategy is to reduce the heel size of shoes gradually. This allows the tendon to slowly stretch and increase its range of motion.