Achilles Tendinitis is a painful condition. Running and walking are made possible by the Achilles tendon, which attaches the calf muscle to the heel bone.
Strenuous exercise, jumping, and climbing are all movements that can strain the tendon and calf muscles, causing an inflammation known as tendinitis. The injury to the Achilles can be mild, requiring only rest and over-the-counter anti-inflammatory drugs, or severe, necessitating surgical repair of the damaged tendon. Chronic Achilles tendinitis can lead to micro tears in the tissue (tendinosis), which weaken the tendon and put it at risk for severe damage such as a tear or rupture.
Inflammation of the Achilles tendon is most often the result of repeated movements associated with physical exercise.
- Implementing a new exercise regiment such as running uphill or climbing stairs
- Change in exercise routine, boosting intensity or increasing duration
- Shoes worn during exercise lack support, either because the soles are worn out or poor shoe design.
- Omitting proper warm-up prior to strenuous exercise
- Running on a hard or uneven surface
- Deformation in foot such as a flat arch, or any anatomic variation that puts unnecessary strain on the Achilles tendon.
Achilles tendinitis symptoms present as mild to severe pain or swelling near the ankle. The pain may lead to weakness and decreased mobility, symptoms that increase gradually while walking or running.
Over time, the pain worsens, and stiffness in the tendon may be noted in the morning. Mild activity may provide relief. Physical exam may reveal an audible cracking sound when the Achilles tendon is palpated. The lower leg may exhibit weakness.
A ruptured or torn Achilles tendon is severely painful and warrants immediate medical attention. The signs of a ruptured or torn Achilles tendon include:
- Acute, excruciating pain
- Impaired mobility, unable to point the foot downward or walk on the toes
- Weight bearing or walking on the affected side is not possible.
A doctor examines the patient, checking for pain and swelling along the posterior of the leg. The doctor interviews the patient regarding the onset, history, and description of pain and weakness. The muscles, tissues, bones, and blood vessels may be evaluated with imaging studies, such as X-ray, ultrasound, or MRI.
TreatmentInitial treatment of mild Achilles tendinitis involves rest, stretching exercises, and non-prescriptive medications to relieve pain and reduce inflammation. These medications include nonsteroidal anti-inflammatory drugs (NSAID) such as ibuprofen or naproxen. Relief of pain and swelling may be achieved with the application of ice for15 minutes at a time.
Sleeping with the affected foot propped up on a pillow may also relieve swelling. Adequate time must be given to rest and recovery, meaning months or weeks, to prevent re-injury of the Achilles tendon. Most people make a full recovery and are able to return to their regular sports and exercise programs.
Physical therapy treatments may be ordered to support rest and anti-inflammatories:
- Massage therapy improves blood flow to the muscles and tissues of the affected area while increasing range of motion and can prevent recurring injury.
- The healing process can be quickened using ultrasound heat therapy to improve blood flow to the affected area.
- Wearing a night brace keeps the leg flexed, preventing stiffening of the tendon, which would impair healing.
- Stretching exercises increase flexibility and allow the tendon to heal without shortening, a deformity resulting in chronic pain.
Persistent Achilles pain may warrant the use of a cast or walking boot to be worn for 4-6 weeks stabilizing the tendon so it can heal. After removal of the cast or boot, physical therapy will be ordered to increase functionality of the affected limb.
To reduce chronic inflammation of the tendon, corticosteroid injections may be prescribed. It’s important to note that this corticosteroid treatment increases the risk of tendon rupture.
Ultrasound imaging may be used by the physician administering the steroid injection, in order to help visualize the affected area.
When all other therapies have failed to or tendon rupture occurs, surgical intervention and repair of the muscles and tendons is the last treatment option.
- WebMD. (January 3, 2011). Achilles Tendon Problems. Retrieved from http://www.webmd.com/a-to-z-guides/achilles-tendon-problems-topic-overview
- Mayo Clinic. (April 29, 2010). Achilles Tendinitis. Retrieved from http://www.mayoclinic.com/health/achilles-tendinitis/DS00737