Achilles Tendonpathy (including tendonitis & tendinosis)
Achilles tendonitis (tendinitis), is a painful and often debilitating inflammation of the Achilles tendon than can progress into degeneration, which we call Achilles Tendinosis. 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 calf muscles to the heel bone.
In most cases, Achilles tendonopathy is an overuse injury and is more common among athletes and people who train heavily. However, it can also occur in people who are less active. Achilles Tendonitis can vary in severity from a mild pain in the tendon during a particular activity to more severe cases when any form of activity that puts strain on the tendon, even standing or walking, can cause pain.
Pain in the back of the heel that can be a shooting pain, burning pain or even an intense piercing pain.
Swelling, tenderness and warmth over the Achilles tendon especially at the insertion of the tendon to the calcaneous, which may even extend into the muscle of the calf.
Difficulty walking – sometimes the pain makes walking impossible.
Pain that is aggravated by activities that repeatedly stress the tendon, causing inflammation or pain that occurs in the first few steps of the morning or after sitting down for extended periods of time, which gets better with mild activity.
It is important to note though that achilles tendinosis can develop gradually without a history of trauma.
Some of the causes of Achilles tendonitis / tendinosis include:
Overuse injury – this occurs when the Achilles tendon is stressed until it develops small tears. Runners seem to be the most susceptible. People who play sports that involve jumping, such as basketball, are also at increased risk.
Arthritis – Achilles tendonitis can be a part of generalised inflammatory arthritis, such as ankylosing spondylitis or psoriatic arthritis. In these conditions both tendons can be affected.
Foot problems – some people with over pronated feet (Flat Feet) or feet that turn inward while walking are prone to Achilles tendonitis. The flattened arch pulls on calf muscles and keeps the Achilles tendon under tight strain. This constant mechanical stress on the heel and tendon can cause inflammation, pain and swelling of the tendon. Being overweight can make the problem worse.
Footwear – wearing shoes with minimal support while walking or running can increase the risk, as can wearing high heels.
Overweight and obesity – being overweight places more strain on many parts of the body, including the Achilles tendon.
Achilles Tendonitis Treatment
The initial aim of the treatment in acute cases is to reduce strain on the tendon and reduce inflammation until rehabilitation can begin. This may involve:
- Avoiding or severely limiting activities that may aggravate the condition, such as running or uphill climbs.
- Using shoe inserts (orthoses) to take pressure off the tendon.
- Wear supportive shoes.
- Reducing Inflammation by icing
- Taking non-steroidal anti-inflammatory drugs
- Heel cups and heel lifts can be used temporarily to take pressure off the tendon, but must not be used long term as it can lead to a shortening of the calf.
- Calf Compression Sleeves
Placing the foot in a cast or restrictive ankle-boot to minimize movement and give the tendon time to heal. This may be recommended in severe cases and used for about eight weeks.
In long term chronic cases of Achilles tendoniitis, where the tendon is no longer inflamed but is degenerated (more appropriately termed, Achilles Tendinosis) strengthening of the muscles that make up the Achilles tendon using eccentric exercise and other rehabilitative activities may be used in conjunction with heat therapy, massage, acupuncture ultrasound and stretching.
Other treatment that may be recommended
You may also be given specific exercises to stretch the calf muscles once the acute stage of inflammation has settled down. However recovery is often slow and will depend on the severity of the condition and how carefully you follow the treatment and care instructions you are given by your podiatrist.
Surgery is considered the last resort and is often performed by an orthopedic surgeon. It is only recommended if all other treatment options have failed after at least six months. In this situation, badly damaged portions of the tendon may be removed. If the tendon has ruptured, surgery is necessary to re-attach the tendon.
Rehabilitation, including stretching and strength exercises, is started soon after the surgery. In most cases, normal activities can be resumed after about 10 weeks. Return to competitive sport for some people may be delayed for about three to six months.
Suggestions to reduce your risk of Achilles tendonitis include:
- Incorporate stretching into your warm-up and cool-down routines.
- Maintaining an adequate level of fitness for your sport.
- Avoid dramatic increases in sports training.
- If you experience pain in your Achilles tendon, rest the area. Trying to ‘work through’ the pain will only make your injury worse.
- Wear good quality supportive shoes appropriate to your sport. If there is foot deformity or flattening, obtain orthoses.
- Avoid wearing high heels on a regular basis. Maintaining your foot in a ‘tiptoe’ position shortens your calf muscles and reduces the flexibility of your Achilles tendon. An inflexible Achilles tendon is more susceptible to injury.
- Maintain a normal healthy weight.
Tendonitis Vs Tendinosis