Achilles Tendonitis

So you've decided to change things up a little. You're going to get in shape! There's just one thing that's stopping you, pain in the back of your ankle. This is most likely Achilles tendonitis, and it's all too common.

Achilles tendonitis is the result of tight calf muscles. Though the Achilles tendon is the strongest tendon in the body, something as simple as not stretching enough can cause irritation and pain with every step. Named after the Greek warrior who could only be mortally wounded in his heel, the Achilles tendon connects the calf to the heel bone and is responsible for moving us forward and keeping that "spring" in our step.

When was the last time you really stopped and stretched your Achilles tendon? If you are like most people, the answer is not recently. Inadequate stretching leads to tight calf muscles. As a result, irritation of the Achilles tendon with any type of activities can occur ranging from walking up and down stairs to starting that rigorous exercise program to shed the extra weight.

As with many other painful conditions in the feet, over-pronation, or flat feet, can lead to Achilles tendonitis as well. Without the proper support, continued walking puts added tension on the Achilles tendon leading to inflammation and pain.

In addition, direct trauma or injury to the Achilles tendon may lead to Achilles tendonitis. At times this type of trauma can cause a complete tear of the tendon. However, the Achilles tendon is extremely strong and this is not very common. More often, the injury will lead to swelling and chronic pain in the back of the ankle.

Achilles tendonitis is characterized by sharp, burning pain in the back of the ankle, about two inches above the heel bone. As with any inflammation, swelling of the area may be involved with redness and increased warmth to the touch. Pressing and squeezing along the Achilles tendon is painful. Stretching the calf muscle or wearing flatter shoes can also cause reproduce the burning sensations in the tendon.

If the condition has been present for a long period of time, more serious symptoms can arise. Thickening and a firmness of the tendon when compared to the opposite leg may be present. Small bumps may be felt where scar tissue forms around the tendon. In severe cases, hardened nodules (calcifications) may be present within the tendon and where it meets the heel bone. This is indicative of a long-standing problem and may cause weakness of the tendon overall.

Conservative, non-surgical treatment of Achilles tendonitis can alleviate and prevent future recurrence in the majority of cases. Stretching of the calf muscles is the first line defense against pain in the Achilles tendon. This must be done prior to any activities and on a regular basis to avoid problems.

Once Achilles tendonitis occurs, treatment is aimed at reducing the inflammation of the tendon. Heel lifts are used to decrease the tension on the tendon while walking. They are added to supportive shoe wear, which is aimed at controlling the foot to avoid over-pronation. A true running or walking shoe with a heel measuring close to one inch aids with further reducing the tension on the tight calf muscles. Icing of the inflamed tendon for periods of 15-20 minutes three times daily coupled with massage of the area is very helpful. If the pain continues, temporarily stopping any activities that cause discomfort is necessary to allow the tendon to rest and recover adequately.

Oral anti-inflammatory medications may be recommended by the foot and ankle specialist for a short period of time. Steroid injections are not typically used to treat Achilles tendonitis. This is due to possible complications of weakening the tendon which may lead to further problems. Physical therapy is often prescribed for a period of 4-6 weeks and is highly successful in relieving the painful symptoms. Casting or the use of a walking boot to immobilize the affected foot and ankle may be necessary in more difficult cases of Achilles tendonitis.

Surgical treatment of Achilles tendonitis may be considered once conservative options have been exhausted and fail to alleviate symptoms. The surgical options range from minimally to highly invasive depending on the severity and degree of disease present.

One of the newer techniques used to surgically manage Achilles tendonitis is radio-frequency treatment. This involves a smaller incision with a shorter surgical and recovery time. A completely noninvasive option is extra-corporeal shock wave therapy, or ESWT. Both radio-frequency treatment and ESWT work to reduce inflammation in the affected area and help the body heal.

With worsening of the tendonitis, the surgical treatment may become more involved. Surgical repair of small tears or removal of scar tissue may be necessary. In addition, if spurring has occurred at the attachment of the tendon to the heel bone, remodeling of this area may be completed requiring a prolonged recovery time.

This information on foot, leg and lower body health conditions is provided by The Podiatry Institute, dedicated to advancing the standard of care in podiatric medicine and its effects on musculoskeletal health. The Podiatry Institute does not endorse a specific treatment, product, or therapy. This information is not intended to be a substitute for professional medical advice, diagnosis or treatment. Please consult your health care provider on all matters relating to this or any other condition that may affect your health.