Achilles Tendinitis – Overview and Treatment

The Achilles tendon is a thick tendon located in the back of the leg. It connects the gastrocnemius and soleus muscles in the calf to an insertion point at the calcaneus (heel bone). It is the strongest tendon in the body and allows people to push off while walking, running, and jumping.

What is Achilles tendinitis?

Tendinitis is when a tendon becomes irritated or inflamed. Inflammation is the body’s response to injury or disease. Tendinitis can be very painful. It’s important to treat Achilles tendinitis. Otherwise, it can become a long-term, chronic problem, making it difficult to walk.

Causes of Achilles Tendinitis?

Achilles injuries can occur in several places, but the most common area is at the muscle-tendon junction, where the calf muscles join with the tendon.

• exercising without a proper warmup
• straining the calf muscles during repeated exercise or physical activity
• playing sports, such as tennis, that require quick stops and changes of direction
• A sudden increase in physical activity without allowing your body to adjust to increased training
• wearing old or poorly fitting shoes
• wearing high heels daily or for prolonged durations
• having bone spurs in the back of your heels
• being older, as the Achilles tendon weakens with age

SYMPTOMS

The main symptom of Achilles tendinitis is a gradual buildup of pain that worsens with time.

The individual may also notice the following:

• The Achilles tendon feels sore a few centimeters above where it meets the heel bone.
• The lower leg feels stiff, slow, or weak.
• A slight pain appears in the back of the leg after running or exercising and becomes more severe.
• Pain in the Achilles tendon occurs while running or a couple of hours after.
• Pain is greater when running fast, for a long time, or when climbing stairs.
• The Achilles tendon swells or forms a bump.
• The Achilles tendon creaks when touched or moved

TREATMENT

Treatment aims to relieve pain and reduce swelling. Methods of treating Achilles tendinitis include:

• Ice packs: Applying these to the tendon can alleviate pain and inflammation when in pain or after exercising.
• Rest: This gives the tissue time to heal. The type of rest needed depends on the severity of the symptoms. In mild cases, it may mean reducing the intensity of a workout, but severe cases might require complete rest for days or weeks.
• Elevating the foot: Keeping the foot raised above the level of the heart can reduce swelling.
• Pain relief: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can reduce pain and swelling. People with asthma, kidney disease, or liver disease should first check with a doctor.
• Steroid injections: Cortisone, for example, can reduce tendon swelling, but it has also been associated with a greater risk of tendon rupture. Giving the injection while scanning the area with ultrasound can reduce this risk.
• Compression bandages and orthotic devices: Ankle supports and shoe inserts can aid recovery as they take the stress off the tendon. Heel lifts, which move the foot away from the back of the shoe, may help patients with insertional Achilles tendinitis.
• Extracorporeal shockwave therapy (ESWT): High-energy shockwaves are used to stimulate the healing process. Results have not been consistent, but if other measures do not work, it might be worth trying before opting for surgery.

It usually takes between a few days and 6 weeks for tendinitis to heal.

Surgery

Surgery can repair the damage sustained by the tendon as a result of Achilles tendinitis. The most common procedure is gastrocnemius recession. This involves lengthening one of the two muscles that make up the calf, to give the ankle a wider range of motion.

Stretches and exercises

A physical therapist can teach stretching exercises to improve flexibility and increase calf strength.

Calf stretch

1. Lean forward with your hands against a wall.
2. Have one foot on the ground, with the leg straight, and one foot in front of it, with the knee bent.
3. Push your hips toward the wall and hold for 10 seconds.
4. Relax and repeat 20 times for each foot.

Bilateral heel drop

1. Stand with the front half of your foot on the stair and the heel off, holding a rail to make sure you are balanced and will not fall.
2. Slowly lift your heels and lower them as far as you can.
3. Repeat 20 times.

Both exercises must be done slowly and in a controlled manner. Doing them fast can increase the damage.

This may help the Achilles tendon to heal and prevent future injury. Physiotherapy is normally more effective for non insertional Achilles tendinitis.