Achilles tendonitis (also tendinitis) is an inflammation of the Achilles tendon, the strong band of tissue that connects the calf muscle to the heel. This condition occurs when excessive stress is put on the tendon. Achilles tendonitis is usually a painful but short-lived condition. It not treated, however, Achilles tendonitis can increase the risk of Achilles tendon rupture, a serious injury requiring immediate medical attention. Most cases of Achilles tendonitis can be prevented by beginning an exercise regimen slowly, with preparation, and by increasing an exercise program gradually and with care.
Causes of Achilles Tendonitis
Achilles tendonitis is usually caused by excessive or repetitive strain on the tendon. It is frequently found in athletes who suddenly increase their activity level, or in middle-aged individuals who exercise intensely but irregularly. Older individuals are at increased risk of injuring the tendon because tendons weaken during normal aging. Movements that may put strain on the Achilles tendon include walking, running, jumping or pushing up onto the toes.
Risk Factors for Achilles Tendonitis
Apart from age and improper preparation for exercise, other risk factors for Achilles tendonitis include:
- Being male, being obese
- Having flat feet or tight calf muscles
- Wearing non-supportive footwear
- Exercising in very cold weather or on hilly terrain
- Having diabetes or hypertension
Taking certain antibiotics, known as fluoroquinolones, such as Cipro and Levaquin, also puts individuals at greater risk of developing Achilles tendonitis.
Symptoms of Achilles Tendonitis
Typically, the pain of Achilles tendonitis initially manifests after engaging in a sports activity as a mild ache in the calf or above the heel. Other symptoms may include:
- Increased pain after running or climbing stairs
- Pain when walking
- General tenderness and swelling at the site
- Stiffness or tenderness upon awakening
- Lessening of pain with mild activity
If a patient experiences severe pain or disability in the region of the Achilles tendon, a ruptured tendon should be suspected and medical attention should be sought immediately.
Diagnosis of Achilles Tendonitis
Achilles tendonitis is usually diagnosed through a combination of physical examination, including an assessment of flexibility, range of motion, reflexes, inflammation and alignment at the injury site, and one or more of the following imaging tests:
- MRI scan
The chief purpose of these imaging tests is to rule out the possibility of a tendon rupture, a more serious injury that requires surgical intervention.
Treatment of Achilles Tendonitis
As with most injuries, conservative methods of treatment are normally tried first, but the initial treatment will depend, to some extent, on the patient's level of pain and dysfunction.
Tendonitis usually responds well to self-care measures, including rest, ice application, and elevation of the affected area, in combination with over-the-counter pain and anti-inflammatory medication.
Assistive Devices and Orthotics
In order to relieve pain and accelerate healing by taking weight off the injured area, assistive devices, such as, walking boots, crutches or canes may be recommended and prescribed. Orthotics, or shoe inserts, may also be suggested to provide a cushion that diminishes pressure exerted on the Achilles tendon.
When over-the-counter medications are insufficient, the doctor may prescribe stronger analgesics or anti-inflammatories.
Physical therapy may be advised as an alternative method of treatment. Physical therapists are trained to instruct and assist in exercises the patient can use to stretch, strengthen and heal not only the Achilles tendon, but the adjacent, supportive region. They may also use laser, ultrasound and electrical stimulation as part of the rehabilitative process.
If diagnostic tests have shown that the Achilles tendon is torn or ruptured, or if the patient doesn't show marked improvement after several months of conservative treatment, surgical repair of the Achilles tendon may be necessary.
If surgical intervention is necessary, most patients will require physical therapy after the operation to regain maximum strength and flexibility.