What is Achilles tendonitis?
Achilles tendonitis is a painful and often debilitating inflammation of the Achilles tendon, also called the 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. The Achilles tendon gives us the ability to rise up on our toes, facilitating the act of walking. Achilles tendonitis can make walking almost impossible. Achilles tendonitis is more common in athletes and occurs in approximately 6-18% of runners. Poorly conditioned athletes are at the highest risk for developing Achilles tendonitis. Participating in activities that involve sudden stops and starts and repetitive jumping (e.g., baseball, basketball, football, tennis, running, dancing) increases the risk for the condition. It often develops following sudden changes in activity level, training on poor surfaces, or wearing inappropriate footwear.
Achilles tendonitis may be caused by a single incident of over stressing the tendon, or it may result from a series of stresses that produce small tears over time. The condition also develops in people who exercise infrequently and those who are just beginning an exercise program as inactive muscles and tendons have little flexibility. It is important for people who are just starting to exercise to stretch properly, start slowly, and increase training gradually.
In some cases, a congenital (i.e., present at birth) condition causes Achilles tendonitis. Typically, Achilles tendonitis is due to abnormal rotation of the foot (pronation), which causes the arch of the foot to flatten and the leg to twist more than normal. This condition also causes the lower leg muscles to stretch more than normal. Like a rubber band, the further the muscles stretch, the tighter they become. Increased force on the Achilles tendon and the heel bone results in Achilles tendonitis.
Because the arch of the foot naturally flattens over time, especially in athletes, Achilles tendonitis often develops later in life. Women who wear high-heeled shoes often and switch to sneakers for exercise also can develop Achilles tendonitis. The Achilles tendon and lower leg muscles gradually adapt to a shortened position because the shoes prevent the heel from stretching all the way to the ground. When this occurs, wearing sneakers or flat shoes forces the Achilles tendon to stretch further than it is accustomed to, causing inflammation. In most cases, symptoms of Achilles tendonitis develop gradually. Pain may be mild at first and worsen with continued activity. Repeated or continued stress on the Achilles tendon increases inflammation and may cause it to rupture. Partial or complete rupture results in traumatic damage and severe pain, making walking virtually impossible and requiring a long recovery period.
Diagnosis for Achilles tendonitis usually involves a physical examination and taking a patient history which may include history of prior pain or weakness in the lower leg, history of recreational activity, and recent changes in activity level, footwear, or training duration or surface. Imaging tests that may be used to help diagnose Achilles tendonitis include x-ray, ultrasound, and MRI.
Achilles Tendonitis Treatment
Treatment for Achilles tendonitis depends on the severity of the injury. If heel pain, tenderness, swelling, or discomfort in the back of the lower leg occurs, physical activity that produces the symptoms should be discontinued. If pain develops even with proper stretching and training techniques, you should consult your podiatrist to check for hyper pronation and adequate arch support. The addition of an orthotic may be enough to maintain good arch and foot alignment and eliminate pain. If damage to the tendon is minor, the injury may respond to a simple course of treatment known as R I C E (which stands for rest, ice, compression, elevation). This is an easy way to remember this home care regimen to reduce pain and swelling. The treatment is as follows:
R: Rest the injured foot/ankle.
I: Ice the area as often as possible. Apply ice to the injury for 20 minutes. Remove the ice pack and wait another 20 minutes. Then ice again. Protect your skin by placing a bandage or thin towel between the ice and your body.
C: Compress (wrap) the swollen foot/ankle with an elastic bandage.
E: Elevate the sprained foot/ankle above your heart level.
A non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen may also be used to reduce pain, swelling, and inflammation. Severe Achilles tendonitis, tendon rupture, or tearing away from the heel bone may require surgery and lengthy rehabilitation. Surgery involves removing the tendon’s inflamed outer covering and reattaching the tissues. Following surgery, patients undergo passive range of motion physical therapy and progressive strengthening exercises for 2-3 weeks. Most activities can be resumed in 6-l0 weeks and competitive sports usually can be resumed after 3-6 months. Proper conditioning and appropriate footwear are the best defense against Achilles tendonitis.
People who engage in physical activity should always warm up and stretch properly before beginning the activity. Cold muscles are inflexible and working them hard without stretching causes excessive stress to the muscles and tendons. If discomfort occurs, the activity should be discontinued immediately and ice should be applied to the affected area to relieve inflammation, if the problem persists or recurs you should consult your podiatrist.
The podiatrists at Foot Centers of NC are highly trained to treat Achilles tendonitis. Due to the variation of symptoms and contributing factors, a specific treatment program is formulated for each individual patient. In order to end the pain and suffering from Achilles tendonitis, be sure to see your podiatrist regularly and follow all instructions in your individualized plan of care.