Achilles tendinitis is a common overuse injury that affects the Achilles tendon. This important tendon runs down the back of the lower leg and connects the calf muscle to the heel bone. It is integral to walking, running, climbing stairs, and jumping. There are many causes of Achilles tendinitis; though it is more common among athletes, it can affect anyone.
Types of Achilles Tendonitis
There are two types of Achilles tendinitis. Noninsertional Achilles tendinitis occurs when the middle part of the tendon begins to wear down. This type is more common in younger, active people. Insertional tendinitis involves the area where the tendon attaches or inserts into the heel bone. This type is usually the result of overuse and affects athletes like long-distance runners, though it can affect anyone at any time.
There are no specific causes for Achilles tendinitis. It occurs from the stress and overuse of being active on your feet. Since the Achilles tendon is used for so many activities, including simply walking, it is often difficult for people to rest the tendon. The body does not have time to heal and repair the tendon when irritation begins, resulting in further swelling and irritation.
Although Achilles tendinitis can affect anyone, there are contributing factors that make injury more likely. Suddenly increasing the amount or intensity of exercise or activity can lead to Achilles tendinitis, as can exercising aggressively with tight calf muscles. Bone spurs can also contribute, as extra bone growth on the heel can rub directly against the tendon, causing pain and inflammation.
General risk factors for Achilles tendinitis include naturally flat feet and obesity, running in worn-out shoes, and running hills or in cold weather. It is more common in people with some medical conditions, like high blood pressure or psoriasis, and as you age. Achilles tendinitis also affects men more than women.
Symptoms of Achilles tendinitis include heel and ankle pain and swelling, stiffness, or tenderness along the back of the lower leg. Discomfort is usually worse in the morning and may improve throughout the day, and it is usually worse after climbing stairs, walking uphill, or after periods of exercise or activity.
To diagnose Achilles tendinitis, the doctor will first do a thorough physical examination, looking for swelling, stiffness, and sensitivity. Imaging tests also help diagnose and treat Achilles tendonitis, including x-rays to examine insertion points and ultrasound to assess the amount of damage to the tendon. MRIs provide more information about the joints affected by Achilles tendinitis, and CT scans can rule out other issues with tendon insertion.
In most cases, doctors recommend conservative treatment for Achilles tendonitis, including rest, NSAIDs, and adaptive footwear. Eccentric stretching exercises, or those that lengthen the tendon rather than shortening it, are very effective, resulting in 40 percent less pain. Extracorporeal shock wave therapy delivers shockwaves to soft tissue and can reduce pain by as much as 60 percent.
If nonsurgical treatment for Achilles tendinitis is ineffective and pain persists for six months, surgical intervention may be necessary. There are a few possible options, depending on the location and severity of the injury. The surgeon may lengthen the calf muscle or use a technique that involves high-velocity saline and ultrasound to break up scar tissue along the tendon, removing unhealthy tissue. If most of the tendon is intact, the surgeon may remove the damaged areas and stitch together the remaining healthy sections. When damage is significant and affects more than half of the tendon, the surgeon may transfer a tendon from the big toe to repair the Achilles tendon.
Complications and Prognosis
Surgical treatment for insertional tendinitis is successful in over 80 percent of cases. Research suggests that the more risk factors a patient has, the less likely the surgery is to be successful. Potential complications include blood clots, persistent nerve pain, infection, and numbness. Open and minimally invasive surgeries are equally as effective, but complications are less likely with minimally invasive surgeries.
It is not always possible to prevent Achilles tendinitis, but there are ways to reduce the risk. When starting a new exercise routine, increase the duration and intensity slowly, and avoid activities like running hills that place added stress on the Achilles tendon. Stop and rest if you notice pain, and make sure you wear shoes that cushion the heel and support your arches. Stretch daily, especially before and after exercise. Cross-train by alternating high-impact activities, like running, and low-impact activities, like biking or swimming. Strengthening the calf muscles can also help prevent an Achilles tendon injury as it helps the tendon better handle the stress of exercise and activity.