Achilles Tendonitis

August 9, 2018

Tendonitis of the Achilles


Achilles tendonitis is typically due to overuse of the tendon, causing irritation and inflammation. The achilles tendon attaches the calf muscle to the foot and withstands the force of running, walking, and stopping. Tight calves, excessive plantar flexion, hyperpronation, and sudden increase in force all increase the risk of Achilles tendonitis .




Types of AchillesTendonitis


Identifying your specific type of Achilles tendonitis is crucial to implementing an effective treatment plan. Here are the most common types.

  • Insertional Achilles Tendonitis

Insertional Achilles tendonitis pain typically occurs at the back of the heel, where the tendon fibers have deteriorated. Pain progresses over time and is more pronounced after intense pushing movements.

  • Acute Achilles Tendonitis

Acute Achilles tendonitis refers to an abrupt injury to the tendon and requires immediate treatment. Pain occurs between the bottom of the calf and the top of the ankle. An acute tendon injury implies damage to the tendon sheath, and severe Achilles tendonitis results in major swelling, intense pain, and an inability to place pressure on the toes.

  • Chronic Achilles Tendonitis

Chronic Achilles tendonitis persists and worsens over a long period of time. Chronic Achilles tendonitis can result from a prior Achilles tendon injury and is common in runners.




What Causes Achilles Tendonitis?


Achilles tendonitis is a wear-and-tear injury typically caused by pressure and stress to the tendon. Along with tendon stress, poor mechanics when running and exercising the lower body can also irritate the Achilles. Here are three common issues that contribute to the development of Achilles tendonitis.


1. Sudden Activity Increase

Suddenly increasing your activity or exercise intensity can cause tendonitis of the Achilles. Adding miles to your running or walking routine results in repetitive stress to the legs and ankles, which can lead to injury. Increase exercise intensity in a slow, progressive manner to avoid injury to or rupture of the tendon.


2. Tight Calf Muscles

The Achilles tendon attaches the calf muscle to the heel. This means a tight calf can put extra tension on the tendon by pulling on the Achilles during dorsiflexion. 


3. Bone Spur

Heel spurs often form near the insertion site of the Achilles which can cause the tendon to rub about the bony projection. If bone spurs aren’t addressed, Achilles tendonitis can become severe.




Achilles Tendonitis Symptoms



Symptoms of Achilles tendonitis are often noticed first thing in the morning and during physical activity. Pain near the heel is relieved by taking weight off the tendon while walking/running activities lead to further irritation. Recognizing the symptoms is key to prompt, effective treatment. Here are common signs of Achilles tendonitis.


  • Morning Pain

Achilles tendonitis is typically more acute in the morning. The sudden pressure on your tendon when you get out of bed causes pain to flare up.

  • Heel Pain

Ongoing pain in the heel region is often accompanied by tightness. Activities involving plantar flexion of the foot further irritates the pain.

  • Thickening of the Tendon

A lump on the back of the leg may indicate the Achilles tendon fibers have begun to break down, swell, and thicken. This thickening will be accompanied by tightness and pain during activities.




Achilles Tendonitis Treatment


The best treatment for Achilles tendonitis depends on the severity of the inflammation. Achilles tendonitis is nearly always treated with non-surgical methods, including home remedies and rest. In more severe cases of prolonged tendonitis, surgical methods or injections may be required.


Home Remedies for Achilles Tendonitis
  • RICE

Healing achilles tendonitis at home begins with the RICE protocol.

  1. Rest. Avoid painful exercises and activities, including running and walking.

  2. Ice. Apply an ice pack to affected areas for ten to twelve minutes, two to four times per day.

  3. Cold therapy reduces swelling and numbs the area to relieve pain.

  4. Compress. Use a bandage to apply compression, reducing swelling and pain.

  5. Elevate. While icing, elevate the leg above the heart.

  • Limit Activity

Avoid any intense activity that irritates the tendon. If the tendon is swollen, use the RICE protocol until swelling has subsided. Do not introduce weight-bearing activities until swelling and inflammation are gone.

  • Medication

Nonsteroidal anti-Inflammatory drugs reduce swelling and inflammation to reduce pain. Always check the dose recommendations listed on the label and consult your doctor before beginning any new medications.

  • Orthotics

Achilles tendonitis is sometimes caused by a flat foot or overpronation. Find shoes with good arch support, and supplement them with insoles or custom orthotics to reduce the strain on the Achilles tendon.

Professional Treatment for Achilles Tendonitis


If you hear a pop when you injure your ankle, suspect a ruptured tendon, or experience severe discomfort, seek professional diagnosis immediately. Your doctor may suggest the following treatments.

  • Cortisone Injections

Cortisone is a powerful anti-inflammatory medication, sometimes used to treat severe cases of Achilles tendonitis. Cortisone injections are not recommended in moderate cases, as they can cause the tendon to rupture.

  • Surgery

As a last line of defense, your doctor may suggest surgery to treat your acute Achilles tendonitis. Common surgical procedures include gastrocnemius recession, débridement and repair, and débridement with tendon transfer.

  • Achilles Tendonitis Physical Therapy

Physical therapy is one of the most effective treatment options for Achilles tendonitis. Your therapy may involve stretching, exercises, shockwave therapy, heat therapy, and massage therapy, and your therapist will likely ask you to supplement your PT with at-home exercises.




Achilles Tendonitis Exercises


Exercise for Achilles tendonitis prevent re-injury. Exercises strengthen the surrounding muscles of the Achilles to take stress off the tendon. You’ll also stretch the calf muscle and soleus muscle to reduce tension and increase mobility.

Gastrocnemius Heel Drop
  1. Stand on a raised surface so your heels are hanging off the edge and your body weight is on the balls of your feet.

  2. Slowly lower your heels as far as is comfortable.

  3. Raise your heels, and repeat 15 reps.

This exercise teaches your body to recruit, contract, and relax the muscles in your calf. It also stretches the calf muscles to relieve tightness in the Achilles tendon.



Soleus Stretch
  1. Stand with one leg in front of the other, close to a wall. Place your hands on the wall for balance and bend both knees.

  2. Move your weight forward onto your toes, keeping your heels on the floor, until you feel a stretch in your outer calf.

  3. Hold for 10 to 30 seconds. Switch legs.

This exercise stretches the calf muscles to relieve pain and improve flexibility and range of motion.




Achilles Tendonitis Relief

Achilles tendonitis recovery time depends on following your doctor’s treatment plan. Avoid weight-bearing activity, such as running or strength training, which can prolong the injury and even rupture the tendon.

Can Achilles tendonitis lead to a rupture?


Achilles tendonitis will lead to a ruptured tendon without immediate rest and treatment. Immediately beginning the RICE protocol and limiting your activity will prevent a ruptured tendon.




Preventing Achilles Tendonitis


To prevent Achilles tendonitis, strengthen the calf, soleus, and arch of the foot. Implement a stretching and strengthening program to prevent tightness and weakness in the tendon. Remember to increase exercise intensity progressively, and consult your doctor immediately if you experience severe or persistent pain.

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