Achilles tendinitis occurs when the large tendon that connects the heel bone to the calf muscle becomes fatigued or overwhelmed leading to persistent aches or pains in this area. Achilles tendinitis is the most common cause of achilles tendon pain and can lead to tears, degeneration, or a complete rupture of the tendon if left untreated.
Tendinitis is a term that refers to the inflammation of a tendon as a result of excessive trauma, repeat trauma, or even non-contact injury. If a tear is assumed to be present then the injury has progressed past tendinitis and will likely require alternate treatment.
There are two main categories of achilles tendinitis, each referring to a different location of injury:
- Insertional achilles tendinitis is the name used for inflammation or pain found at the bottom of the achilles towards the heel where the tendon connects to the bone. This is usually the result of an overuse injury and is commonly seen in patients who spend long hours on their feet either working labor or running long distances.
- Non-insertional achilles tendinitis is when the inflammation is in the middle of the tendon. This is the most common form of achilles tendinitis and is usually seen in young athletes.
If left untreated achilles tendinitis can lead to tendinosis, which is the degeneration of the tendon, or even to a tear or rupture of the tendon in more extreme cases.
Achilles tendon issues are most common in athletes, but are not exclusively sport-related. Other activities that may lead to this condition are:
- Running
- Dancing
- Weightlifting
- Labor or work that keeps you on your feet for long hours
- Intense impact that the body is not prepared for like jumping off of an elevated surface, or even redirecting yourself too quickly
Other factors that might contribute to an achilles injury:
- Tight calf muscles
- Excessive pronation of the foot (rolling inwards)
- Bone spurs in the heel
- Collapsed arches
Diagnosis of Achilles Tendinitis
To diagnose an achilles tendon injury your doctor will ask you to describe your symptoms and when you first started to notice them. They will then likely ask if you have taken on any new activities or if you spend a lot of time on your feet. A basic physical exam will be done as well to
assess your range of motion and the location of the pain. If a serious injury is expected you will be brought in for a x-ray, an MRI (magnetic resonance imaging), or an ultrasound to better diagnose the extent of the injury.
If achilles tendinitis is diagnosed and there are no apparent tears or signs of degeneration in the tendon, non-surgical treatment will be the first thing that your doctor recommends. Some non-surgical options might include:
- Calf stretches
- Calf strengthening exercises
- Change in footwear
- Overnight splint to help stretch the calf muscle
- Anti-inflammatory drugs like ibuprofen
- Walking boot if the pain is severe
- Physical therapy
- Cortisone injections
- Or even shockwave therapy
Nonsurgical Treatment
If the problem persists or the pain becomes unbearable, surgery will be your next option. You will typically be asked to attempt the non-surgical options for around 6 months before surgery is considered, and at that point the procedure will depend on the nature and location of the injury.
Surgery for Achilles Tendonitis
Debridement is when a doctor performs a surgery to remove damaged tissue. In the case of achilles tendinitis the doctor will remove any damaged tissue present on the achilles tendon as well as any bone spurs that might exist on the heel. The tendon is then reattached or reinforced with an anchor (usually metal or plastic) and a strong set of stitches.
Another option is debridement with tendon transfer. If too much of the achilles tendon is compromised and needs to be removed- roughly 50 % or more in most cases- then the tendon needs to be reinforced with a portion of tendon taken from elsewhere in the body. The most commonly relocated tendon is the flexor hallices longus (FHL) that runs along the bottom of the big toe. Patients rarely notice a change in stride, mobility or balance as a result of this transfer.
Another common surgery performed for this condition is a gastrocnemius recession, where the doctor makes a small incision in the calf region to access and lengthen the muscle, therefore relieving tension on the achilles tendon. This prevents the larger of the calf muscles (the gastrocnemius) from pulling on the heel too much. This procedure is generally only necessary if the injury is the result of tight calf muscles that do not respond well to physical therapy.
Surgeries like the ones mentioned above have a high success rate, but due to the nature of tendon injuries recovery can be a slow process. Rehabilitation can be required for up to a year post operation, but this extended process will greatly increase the likelihood of a full recovery.
If you have questions concerning these procedures or would like to contact a physician to discuss your symptoms, please contact us.