Achilles tendinitis is a common condition caused by overuse or degeneration of the Achilles tendon (the band of tissue that connects calf muscles at the back of the lower leg to your heel bone), resulting in inflammation and irritation. The Achilles tendon is the largest tendon in your body, connecting your calf muscles to your heel bone. It is used when you walk, climb, run and jump and is most common in runners that have a sudden increase in the intensity or duration of their runs. It is also very common in middle-aged people who semi-regularly partake in sports such as tennis or basketball.
The majority of cases of Achilles tendinitis can be treated with at-home care under your doctor’s supervision. Self-care strategies are usually necessary to prevent recurring episodes. More-serious cases of Achilles tendinitis can lead to tendon tears (ruptures) that may require surgical repair.
Symptoms of Achilles Tendinitis
The most noticeable sign to look out for is pain above your heel when stretching your ankle or standing on tiptoes. Episodes of more severe pain can develop following prolonged running, climbing or sprinting.
Other common symptoms of Achilles tendinitis include:
- Pain and stiffness in the Achilles tendon, particularly in the morning
- Extreme pain the day after exercising
- Thickening of the tendon
- Bone spur (insertional tendinitis)
- Swelling or hard knots that are present all the time and gets worse throughout the day
- A cracking or creaking noise when moving the ankle or pressing on the Achilles tendon
- Weakness in the affected leg
If you feel a sudden “pop” in the back of your calf or heel, or experience instant and severe pain, you may have ruptured (torn) your Achilles tendon. See your doctor immediately if you think you may have torn your tendon.
Causes of Achilles Tendinitis
Achilles tendonitis is generally an overuse injury, caused by repeated movements and unrelated to a specific injury. The Achilles tendon is used when you walk, run, jump or push up on your toes. The Achilles tendon weakens with age, which can make it more vulnerable to injury; especially people who sporadically participate in sport or have suddenly increased the intensity of their exercise regime. Other factors that can increase the risk of developing Achilles tendinitis include:
- A sudden increase in exercise
- Not warming up before exercising
- Exercising in non-supportive or ill-fitting shoes or trainers
- Not stretching the Achilles tendon and back of the leg following activity or exercise
- A direct blow to the area
Diagnosis
In some cases, an Achilles tendon injury can be mistaken for a sprained ankle. To make the right diagnosis, your doctor will begin by asking about your symptoms, followed by a physical examination. Your doctor will gently press on the affected area to determine the location of the pain, swelling and tenderness. They may also want to see you run or walk to check for problems that may have caused your injury.
Your doctor may test your range of motion to see if you can move your ankle the way you should and assess your reflexes. They may also suggest imaging tests. Further tests that may be carried out include:
X-rays
X-rays are unable to see soft tissues such as tendons. However, they can be useful to help rule out other conditions that can cause similar symptoms.
Magnetic Resonance Imaging (MRI)
An MRI scan uses radio waves and a strong magnet to produce detailed images of the Achilles tendon. If surgery is necessary, an MRI scan will help your doctor choose the surgical procedure based on the amount of tendon damage.
Ultrasound
An ultrasound uses sound waves to visualise soft tissues such as tendons. It can show the Achilles tendon in motion, related damage and inflammation.
Treatment for Achilles Tendinitis
Many treatments are available for Achilles tendinitis including home remedies, injections, physiotherapy and surgery. Tendinitis generally responds well to self-care treatment; however, if your symptoms persistent or are severe, your doctor may suggest more invasive treatment.
If over the counter pain medication such as ibuprofen is not relieving the pain and inflammation, your doctor may suggest stronger medication such as cortisone injections. However, cortisone injections are uncommon in the treatment of Achilles tendinitis as they can cause the tendon to tear (rupture).
A physiotherapist may suggest some of the following treatment options to help ease pain and inflammation:
Exercises
Specific stretching and strengthening exercises are recommended to encourage healing and strengthening of the Achilles tendon.
Eccentric strengthening involves a slow let down of a weight after raising it and has been found to be particularly helpful for persistent Achilles problems. Eccentric strengthening exercises can result in damage to the Achilles tendon if they are not performed properly, and so it is important that they are initially carried out under supervision of a physiotherapist. These exercises can cause discomfort; however, it shouldn’t be unbearable if carried out correctly.
Orthotic devices
A shoe wedge or insert that slightly elevates your heel can help relieve strain on the tendon and offer a cushion that reduces the amount of force applied to your Achilles tendon.
Home treatments includes the following steps, often referred to by the acronym R.I.C.E.
Rest
Try to avoid exercise for several days or change to an activity that does not strain the Achilles tendon, such as swimming. In extreme cases, you may be required to wear a walking boot and use crutches.
Ice
To ease pain or swelling, apply an ice pack to the tendon for around 15 minutes following exercise, or when you are in pain.
Compression
To reduce swelling and movement of the tendon, wraps or compressive elastic bandages can help.
Elevation
Raising the affected foot above the level of your heart can reduce swelling. Try sleeping with your affected foot elevated throughout night.
Surgery
If conservative treatments have not worked or if the tendon has torn (ruptured), your doctor may suggest surgery. The specific type of surgery depends on the location of the tendinitis and the level of damage to the tendon.
During open surgery, an incision is made in the back of the calf. If the tendon has ruptured, the doctor will stitch the tendon back together. If the tendon is degenerated, the doctor may remove the damaged parts and repair the remaining tendon with stitches. If there is severe damage, the doctor may replace a portion or all of your Achilles tendon with a tendon taken from another area in the foot.
Sometimes, the Achilles tendon repair surgery can be carried out as a minimally invasive procedure. This is performed with several small incisions instead of one large one. Your doctor may use a special scope with a tiny camera (arthroscope) and a light to help do the repair.
Risks and Complications
Moderate to severe pain following surgery is the most common complication and occurs in a small percentage of patients. If you continue to put stress or wear on to your Achilles tendon after surgery, your tendon may be prone to tearing or rupturing. It is important to follow your doctor’s advice so that you can minimise the risk of complications.
As with any type of surgery, there is always a risk of complications. Risks of Achilles tendon repair include:
- Excess bleeding or blood clots
- Nerve damage
- Infection (difficult to treat in this location)
- Wound healing problems
- Weakness in the calf
- Anaesthetic complications
The risk of complications occurring vary depending on age, the shape of your foot and leg muscles and tendons, your overall health and the type of surgery performed. Speak to your doctor regarding any concerns you may have.
Post-Operative Recovery
Most patients experience positive results following surgery. The main factor in surgical recovery is the amount of damage to the tendon. The more tendon involved, the longer the recovery process, and the less likely a patient will be able to return to sporting activities.
Physiotherapy is an important step in recovery. Many patients need months of rehabilitation before they are pain-free. You can still be active whilst your injury heals. Make sure you speak with your doctor and do not try to return to your previous level of physical activity until you can move your leg as freely and easily as your unaffected leg. Your injured leg needs to be just as strong as your uninjured leg and you do not have pain when you walk, jump, sprint or jog.
Outlook
Achilles tendinitis usually goes away after a few days, following rest and home treatment. Recovery can take longer if you do not change your activity or exercise habits and continue to put stress on the tendon.
It is important to seek treatment for your tendinitis or ruptured tendon right away. Carefully following your doctor’s instructions will provide you with a better chance for a quick and full recovery.
Need Help?
If you are experiencing pain in your foot or ankle and you think it could be Achilles tendinitis, you can be seen by a Consultant Orthopaedic Foot and Ankle Surgeon at One Ashford Hospital, usually within 48 hours. One Ashford Hospital is well placed to see patients with knee injuries from Ashford, Maidstone, Canterbury, Folkestone, Dover and all surrounding villages. To book an appointment, call the hospital direct on 01233 364 022 or email here.
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