Achilles Tendinitis

The achilles tendon, which connects the heel bone to the calf muscle, is the body's largest tendon and is crucial for walking, running, and jumping. Pain in the Achilles tendon can result from several causes, including:

Achilles tendinitis due to the overuse of the Achilles tendon.
Achilles tendinosis is a condition where the tendon deteriorates due to unresolved tendinitis.
Achilles tendon rupture will result in marked pain and discomfort.

Achilles tendinitis can become chronic, impacting walking and daily activities.

How many types of Achilles tendinitis?

Non-insertional Achilles tendinitis occurs when the fibers in the middle of the tendon become inflammatory, swollen, and thickened. It is commonplace in young people and those who exercise strenuously, especially with high-impact and jumping workouts.
Insertional Achilles tendinitis affects where the tendon connects to the heel bone. It can affect people who are not physically active or engage in repetitive strain on the tendon, such as long-distance runners.

What are the symptoms of Achilles tendonitis?

Pain in the ankle and heel
Your tendon in the ankle becomes stiff, tender, and swollen.
You develop leg weakness.
With a ruptured Achilles tendon, you will have discomfort around your ankle after exercising or while climbing stairs or walking uphill.
The discomfort is present in the morning, improves during the day, and worsens at night due to cumulative repetitive stress.

What causes Achilles tendonitis?

Achilles tendinitis occurs when there is overuse of the Achilles tendon from activities that put repetitive strain on the tendon, such as prolonged walking or running. The body does not have adequate time to heal the damaged tendon, causing swelling, irritation, and inflammation.

When to see a doctor?

Seek medical care if the pain around the Achilles tendon does not improve or resolve. Immediately see your doctor if you experience severe pain or you are unable to walk because your Achilles tendon may have ruptured.

Risk factors that cause Achilles tendonitis

Gender: Achilles tendinitis is more common in males than females.
Age: The older you get, the higher the risk of Achilles tendinitis.
Physical factors: Factors such as having a flat foot can place additional strain on the Achilles tendon. Being overweight or having tight calf muscles can also accentuate tendon strain.
Training methods: Running uphill or with improper shoes can elevate the risk of Achilles tendinitis. Exercise in cold weather has also been associated with a higher occurrence of tendon pain when compared to warm weather.
Medical conditions: Psoriasis, rheumatoid arthritis, hypertension, and diabetes have increased risk of Achilles tendinitis.
Certain medications: such as fluoroquinolones, a class of antibiotics, have been linked to increased rates of Achilles tendinitis.

How is Achilles tendonitis diagnosed?

History taking and physical exam: Doctors will examine your ankle to locate the site of pain, swelling, and tenderness and assess the flexibility, motion, and foot and ankle alignment.
Imaging tests
- X-rays can assist in ruling out other conditions that may present with similar symptoms.
- Ultrasound can produce real-time images of the Achilles tendon in motion and detect bone spurs.
- MRIs can generate highly detailed images of the Achilles tendon to identify the levels of degeneration and rupture of the Achilles tendon.

How is Achilles tendonitis treated?

Achilles tendinitis can improve and resolve with home remedies. However, if you develop persistent symptoms, additional treatments may be necessary.

Medications: Doctors may prescribe anti-inflammatory medication and muscle relaxants.
Physical therapy can promote healing through specific stretching and strengthening exercises, eccentric exercises, and orthotic devices such as a shoe insole.
Surgery can be an option if the abovementioned treatment cannot ease the pain and improve your symptoms within six months.
Gastrocnemius recession: The surgeon lengthens the calf muscles using an endoscope to alleviate tension in the Achilles tendon.
Debridement and repair: If most of the tendon remains healthy, the surgeon will remove only the fibrotic portion of the Achilles tendon and suture together with the remaining healthy tendon. Following the procedure, you will likely need to wear a boot or cast for a few weeks.
Debridement with tendon transfer: When more than half of the Achilles tendon is damaged, a tendon transfer becomes necessary as there is insufficient healthy tendon left for proper function. The surgeon transfers a flexor tendon of the big toe to the heel bone, allowing you to walk and perform regular activities.

Prevention

Wear training shoes with cushioning heel pads and provide firm arch support. Replace worn-out shoe insoles.
Be mindful of your body's limits. Avoid activities that put excessive strain on your tendons, like running uphill. Before engaging in vigorous or high-intensity exercise, you must warm up and take a break if you experience pain.
When beginning to work out, avoid going overboard. Gradually increase the intensity and lengthen the duration of your training sessions.
Strengthen your calf muscles. If you enjoy working out, try cross-training. Switch between high-impact exercises like running and jumping and low-impact activities like cycling and swimming.
Stretch your calf muscles and Achilles tendon before and after exercise to enhance flexibility and prevent Achilles tendinitis.

Home remedies

If you have an acute Achilles tendinitis episode, follow the R.I.C.E. self-care measures.

Rest. Have adequate rest. Refrain from exercising for a few days or opt for low-impact activities like swimming.
Ice. After exercising or when experiencing pain, apply an ice pack to the affected tendon for approximately 15 minutes. It can help alleviate pain and reduce swelling.
Compression. Wrap the affected area with compression elastic bandages to relieve swelling and limit movement of the tendon.
Elevation. Elevate the impacted foot above heart level when resting or sleeping to reduce swelling.

Preparation for doctor's appointment

Before seeing your doctor, you can prepare answers to the following questions:
Where is the location of the pain?
Did you suddenly or gradually experience pain in the ankle?
Does the pain diminish with rest?
Do symptoms intensify at specific times of the day or after particular activities?
Have you tried any home remedies?
Can you describe your usual exercise regimen?
What kind of footwear do you typically wear during exercise?
Are you taking any medication or supplements?