Achilles Tendonitis - Care Guide

Achilles tendonitis is tendinitis of the Achilles tendon, characterized by swelling of the Achilles tendon. It is a painful and often debilitating condition of irritation and inflammation of the large tendon in the back of the Achilles tendon (heel cord). The Achilles tendon is the largest and strongest tendon in the body. It is located in the back of the lower leg, attaches to the heel bone (calcaneus), and connects the leg muscles to the foot.

Achilles tendonitis is a chronic injury that occurs primarily from overuse and tends to occur in middle-age recreational athletes. It tends to come on gradually over time until pain is constant and exercise or activity too painful to continue. Achilles tendonitis can lead to small tears within the tendon, and make it susceptible to rupture. If it is not treated properly, a simple Achilles tendon injury can progress into Acute Achilles Tendonitis and make walking impossible. Podiatrists recommend that the condition be treated as early as possible.

Achilles Tendonitis Symptoms

Achilles Tendinitis does not happen overnight, and usually does not manifest itself right away. Pain is usually mild at first, but it worsens with continued activity. 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. In the early stage of Achilles tendon injury, called Peritenonitis, has no visible symptoms. You may feel pain during activity or while at rest, but will not see any physical manifestation of damage. As achilles tendon injury progresses, you may begin to notice some swelling or hard knots of tissue on the back of the leg.

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. Achilles tendonitis can be due to several other conditions that may include:

The biggest cause of chronic Achilles tendonitis is ignoring early warning signs and pushing through pain. If the Achilles tendon is sore, or aches, you need to pay attention and rest it immediately. 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. Although Achilles tendonitis is more common in poorly-conditioned athletes, non-athletes can also develop the condition because of everyday stress on the feet and other factors. Sudden increases in training, hill running or a lot of speed-work can also lead to Achilles tendonitis.

Sudden changes in footwear may also cause Achilles tendonitis. When the feet are always high heels, for example, the Achilles tendon adapts overtime to a shortened position because the heeled shoes keep the heel bone from stretching all the way to the ground. When the feet suddenly wear flats, Achilles tendons are forced to stretch more. This unfamiliar stretch can cause inflammation.

Achilles Tendonitis Diagnosis

The symptoms associated with diagnosis of Achilles are typical and can be elicited by a thorough history. A physical examination is used to determine the location of the problem. Most tendons are near the surface of the skin and can be easily touched or pressed in order to make a diagnosis. Pressure placed directly on these tendons is likely to cause discomfort. In addition, your doctor may ask you to contract the muscle attached to the tendon, usually against resistance, to see if this causes pain. 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.

Achilles Tendonitis Treatment

At the first sign of Achilles tendon pain, reduce or discontinue the activity that caused the condition until the tendons recover. Begin gentle calf stretching after the activity, when the muscle and tendon are still warm and flexible. Avoid excessive stretching that could aggravate the problem. Simple treatment is possible with ice, cold compression therapy, wearing heel pads to reduce the strain on the tendon, compression that accelerates healing by improving circulation, and an exercise routine designed to strengthen the tendon.

Resting the painful Achilles tendon will allow the inflammation to subside and allow for healing. A period of rest after the onset of symptoms is important in controlling Achilles tendonitis. Using elastic bandages while sleeping can reduce morning stiffness but care must be taken to apply very light compression during sleep. Also, to ease the pain put ice on the area (usually for 20 minutes every hour for one to two days to reduce swelling), elevate the feet whenever possible, and compress the area with elastic bandage.

Problems with foot mechanics can also be treated with orthotics, devices inserted into the shoes. Products such as heel cups, arch supports, and custom orthotics can be used to correct for abnormalities such as over-pronation and help prevent Achilles tendonitis. Othortics help the patient maintain a good arch and foot alignment. Overtime, this eases the pain.

If this does not solve the problem, doctors may ask the patient to undergo basic rehabilitation and perform stretching and training techniques. Physical therapists can help formulate a stretching and rehabilitation program to work on flexibility of the Achilles tendon.  More specialized therapies include prolotherapy (sclerosant injection into the neovascularity) and lithotripsy.

Chronic Achilles Tendonitis is corrected by surgery. The tendon's swollen outer is removed and all the torn tissues are reattached. A two- to three-week therapy follows the surgery. If the treatment is successful, the patient can resume physical activities in about six to 10 weeks.

It is not necessary to stop activity completely (you may consider cross training) as long as you pay attention to muscle soreness and reduce activity accordingly. Strengthening the calf muscle can help reduce the stress on the Achilles tendon. Toe raises, and balancing on your toes, and wall stretching are useful exercises.

Achilles Tendonitis Prevention

The best treatment of Achilles tendonitis is prevention. Stretching the Achilles tendon before exercise, even at the start of the day, will help to maintain flexibility in the ankle joint. Prevention includes following appropriate exercise habits and wearing low-heeled shoes. A physical therapist or athletic trainer can prescribe safe exercise methods.