Achilles Tendonitis (aka Tendinitis) is a condition where the Achilles tendon is inflamed or irritated. The Achilles tendon is the band of tissue that connects calf muscles at the back of the lower leg to your heel bone. Athletes are especially prone to chronic Achilles Tendonitis. It is often a running injury or other sport-related injury resulting from overuse, intense exercise, jumping, or other activities that strain the tendon and calf muscles.
Leg muscles are the most powerful muscle group in the body and the Achilles tendon is the thickest and strongest tendon in the body. Contracting the calf muscles pulls the Achilles tendon, which pushes the foot downward. This contraction enables: standing on the toes, walking, running, and jumping. Each Achilles tendon is subject to a person’s entire body weight with each step. Depending upon speed, stride, terrain and additional weight being carried or pushed, each Achilles tendon may be subject to up to 3-12 times a person’s body weight during a sprint or push off.
Signs and Symptoms
It does not happen overnight, and usually does not manifest itself right away. Pain is usually mild at first, but worsens with continued activity.
The first stage of the Achilles tendon injury, called Peritenonitis, has no visible symptoms. The patient may feel pain during activity or while at rest, but will not see any physical manifestation of damage.
As the injury progresses to the second stage (called Tendinosis), the patient may begin to notice some swelling or hard knots of tissue on the back of the leg.
If the feet are subjected to more physical activity and strain, the tendon may partially or completely rupture. This is the third stage (referred to as Peritenonitis with Tendinosis). The result is traumatic damage to the tendons – a condition that can impair the legs from walking and require extended recovery period.
It is also associated with more defined symptoms like:
- Mild ache or pain at the back of the leg and above the heel after running or other sports activity
- Episodes of more severe pain associated with prolonged running, stair climbing or intense exercise, such as sprinting
- Tenderness or stiffness, especially in the morning, that usually improves with mild activity
- Mild swelling or a “bump” on your Achilles tendon
- A crackling or creaking sound when you touch or move your Achilles tendon
- Weakness or sluggishness in your lower leg.
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. Some factors that contribute to the onset of Achilles tendonitis are:
- A rapid increase in the distance or speed of a running regimen
- New or intense hill running or stair climbing
- Activities that require jumping, sudden starts and stops, or other repetitive movements such as basketball, jogging, dancing or tennis
- Exercising without warming up
- A new, intense exercise regimen after a long period of not exercising regularly
- Poor flexibility in the calf muscles
- Running on uneven or hard surfaces
- Wearing shoes that are worn out or inappropriate for the activity
- A naturally flat arch, which can put more strain on the Achilles tendon
- Other slight variations in the foot, ankle or leg anatomy that may put extra strain on the tendon
- Traumatic injury to the tendon
Treatments and drugs
Tendonitis is usually treated with relatively simple interventions, but successful treatment requires patience and careful adherence to treatment guidelines. Your foot care specialist is likely to recommend a combination of interventions such as:
- Self-care strategies
- Pain medications
- Stretching and exercises
Self-care includes the following steps, often known by the acronym R.I.C.E.:
- Rest. Rest is essential for tissue healing. Depending on the severity of your symptoms, resting may mean not exercising for several days; reducing the duration and intensity of your routine; or switching to an activity that doesn’t strain the Achilles tendon, such as swimming.
- Ice. To decrease pain or swelling, apply an ice pack to the tendon for about 15 minutes after exercising or when you experience pain.
- Compression. Wraps or compressive elastic bandages can help reduce swelling and reduce movement of the tendon.
- Elevation. Raise the affected foot above the level of your heart to reduce swelling. Sleep with your affected foot elevated at night.
Your doctor is likely to recommend a prescription-strength or over-the-counter non-steroidal anti-inflammatory drug to reduce inflammation and relieve pain.
Stretching and exercise
Appropriate stretching and exercise can promote healing and prevent recurring problems. Your foot care specialist can demonstrate the proper technique or refer you to a physical therapist or specialist in sports medicine. These techniques include:
- Stretching with knees straight. Lean against a wall with your knees straight and heels on the floor to stretch the upper portion of calf muscles.
- Stretching with knees bent. Place the foot forward and flex the knee and ankle with the heel flat on the floor to stretch the lower portion of calf muscles.
- Exercising calf muscles.Toe raises or the use of a calf-strengthening machine can help make the tendon stronger and treat Achilles tendon problems. A special type of strengthening called “eccentric” strengthening has been shown to be especially effective in treating chronic tendon problems. An example of this type of exercise to strengthen the calf muscle is slowly descending to the ground after rising on your toes.
Additional treatments may include the following:
- Arch Supports (Orthotics) protect or change the position of the foot and ankle in order to promote healing. A shoe insert that slightly elevates your heel can relieve strain on the tendon and provide a cushion that lessens the amount of force exerted on the tendon.
- Corticosteroid injections may be used with caution to reduce inflammation around a tendon that has been chronically inflamed. An increased risk of tendon rupture has been observed with this treatment. To lower that risk, your doctor may use ultrasound imaging to ensure that he or she injects the corticosteroid near the target site while avoiding a direct injection into the tendon.
- Surgeryto repair damaged tissue and improve function of the tendon is considered only when several months of more conservative treatments don’t work or if ongoing inflammation results in partial or complete rupture of the tendon.
While it may not be possible to prevent Achilles tendonitis, you can take measures to reduce your risk:
- Increase your activity level gradually. If you’re just beginning an exercise regimen, start slowly and gradually increase the duration and intensity of the training.
- Choose your shoes carefully. The shoes you wear while exercising should provide adequate cushion for your heel and should have a firm arch support to help reduce the tension in the Achilles tendon. Replace shoes that show excessive wear. If your shoes are in good condition but don’t support your feet, try arch supports in both shoes.
- Stretch daily. Take the time to stretch your calf muscles and Achilles tendon in the morning, before exercise and after exercise to maintain flexibility. This is especially important to avoid a recurrence of Achilles tendonitis.
- Strengthen your calf muscles. Strong calf muscles enable the calf and Achilles tendon to better handle the stresses they encounter with activity and exercise.
- Cross-train. Alternate high-impact activities, such as running and jumping, with low-impact activities, such as cycling and swimming.