Tendons are the bands of connective tissue that connects muscles to bones. It pulls against bones when muscles contract and together with the joints, these structures allow for movement of different body parts. The Achilles tendon is the largest tendon in the body, located at the back of the ankle. It has to contend with significant force throughout life and is therefore more likely to be injured and strained.
What is Achilles tendonitis?
Achilles tendonitis is inflammation of the Achilles tendon. It is more likely to occur with overuse, strain or injury. Inflammation can weaken the tendon and increase the risk of a rupture (tear). Achilles tendonitis is not serious and can usually be managed with simple home care. However, if it becomes chronic or a rupture occurs then medical and surgical treatment may be necessary.
Types of Achilles Tendonitis
Achilles tendonitis may be categorized as insertional or non-insertional. This depends on where the Achilles tendon if affected. Insertional Achilles tendonitis is inflammation of the Achilles tendon where it attaches to the heel. Non-insertional Achilles tendonitis is inflammation in the middle of the tendon. Apart from inflammation, there also be tiny tears and degeneration of the tendon.
Causes of Achilles Tendonitis
The Achilles tendon is the largest tendon in the body and connects to the calf muscles (muscles at the back of the lower leg) to the heel. When these muscles contract it pulls the foot downwards and backwards (plantar flexion).
The muscles exert the force on the foot through the Achilles tendon. It is an important movement when walking and running, as the foot pushes against the ground to move the body forward. This action of the calf muscles and movement of the foot also enables us to stand tiptoe and jump.
Although the Achilles tendon is capable of withstanding major force over a period of time, it can be strained and injured. This is more likely to occur with prolonged use and in activities exerting forces that the tendon is not conditioned to withstand.
Runners are particularly prone to Achilles tendonitis, especially when they overexert themselves. Similarly people who play sports occasionally are more likely to develop Achilles tendonitis as the tendon is not conditioned to suddenly deal with the exertion.
Read more on causes of Achilles tendon pain.
Who is at risk of Achilles tendonitis?
The condition is also more likely to occur with advancing age. The tendon weakens as a person gets older and is therefore prone to injury. For example, middle aged people who play a sport every now and then which involves running and/or jumping are more likely to develop Achilles tendonitis.
Bone spurs on the heels and tight calf muscles are other factors that can also contribute to Achilles tendonitis. Obesity, worn out shoes, having high blood pressure and psoriasis or using certain medication like some types of antibiotics may also increase the risk of Achilles tendonitis.
Signs and Symptoms
The signs and symptoms of Achilles tendonitis typically arises after an episode of exertion, like running a long distance or playing a sport. Even walking for long distances when the body is not condition for that level of exertion may give rise to Achilles tendonitis symptoms by the next day.
- Pain in the back of the ankle which may start as a mild ache but eventually becomes severe.
- Tenderness above the heel and at the back of the ankle where the tendon is located.
- Stiffness of the ankle (reduced range of motion) which tends to ease with activity.
- Swelling at the back of the ankle that worsens with activity.
- Thickening of the tendon which may not always be detectable.
These episodes may last for days, weeks or even months. The above symptoms along with a popping sound and severe pain in the back of the calf with an inability to push off the affected foot is more likely to be due to an Achilles tendon rupture rather than just tendonitis.
Read more on ankle pain.
Treatment of Achilles Tendonitis
Achilles tendonitis can be managed with simple home care measures. Resting the affected leg and applying ice to the area of the Achilles tendon is often effective to ease the inflammation. Bandaging the area (compression) helps to reduce movement and elevating the foot may ease swelling. This is known as the R.I.C.E. method – rest, ice, compression and elevation.
It may take several days for the symptoms to ease. Over-the-counter (OTC) anti-inflammatory drugs such as ibuprofen and naproxen may also be helpful during this time. However, if the symptoms are not easing then stronger anti-inflammatory medication and possibly painkillers that are prescribed by a doctor may be necessary.
Exercise and physical therapy are essential for treating and preventing Achilles tendonitis that either does not resolve with self care measures or recurs frequently. This helps with both stretching and strengthening the Achilles tendon. Orthotic devices that elevate the heel and reduces force on the tendon may also be helpful for both treating and preventing Achilles tendonitis.
Surgery for Achilles Tendonitis
Surgery is usually necessary for an Achiles tendon rupture) but is only sometimes considered for Achilles tendonitis. If the symptoms of Achilles tendonitis persists for more than 6 months, then surgery may be suggested as an option for treating the condition. Surgery may involve reducing tension on the tendon, removing a portion of the tendon or transferring another tendon to strengthen the damaged Achilles tendon.
How To Prevent Achilles Tendonitis
Achilles tendonitis is preventable in many instances with some of these simple lifestyle measures.
- Avoid vigorous physical activity. This may not always be possible but should be minimized. For example, do not suddenly play a full game of a sport if it is not a regular activity.
- Increase physical activity gradually. Allow the tendon to become conditioned to the exertion and adapt accordingly. Do not suddenly undertake vigorous physical activities.
- Do stretching and strengthening exercises. These exercises help prepare the Achilles tendon and calf muscles for exertion.
- Wear appropriate shoes. The footwear should not only help cushion the foot but also provide heel support to reduce tension on the Achilles tendon.