About Achilles Tendinitis
What is Achilles Tendinitis?
Achilles tendinitis is a common condition that occurs when the large tendon that runs down the back of the lower leg becomes irritated and inflamed.
The Achilles tendon is the largest tendon in the body. It connects the calf muscles to the heel bone and is used when you walk, run, climb stairs, jump, and stand on your tip toes. Although the Achilles tendon can withstand great stresses from running and jumping, it is also prone to tendinitis, a condition associated with overuse.
Simply defined, tendinitis (also spelled "tendonitis") is acute inflammation of a tendon. Inflammation is the body's natural response to injury and often causes swelling, pain, or irritation. You may also come across the term "tendinopathy," which is used to describe a condition in which the tendon develops microscopic degeneration as a result of chronic damage over time. Tendinitis, tendinosis, and tendinopathy are all common terms which essentially refer to the same problem.
Noninsertional Achilles Tendinitis
In noninsertional Achilles tendinitis, fibers in the middle portion of the tendon (above where it attaches to the heel) are affected. Over time, the fibers may begin to break down and develop tiny tears. This can lead to tendon swelling and thickening. Noninsertional tendinitis more commonly affects younger, active people, especially runners.
Insertional Achilles tendinitis
Insertional Achilles tendinitis involves the lower portion of the tendon, where it attaches (inserts) to the heel bone (also known as the calcaneus).
In both noninsertional and insertional Achilles tendinitis, damaged tendon fibers may calcify (harden) over time. Bone spurs often form on the heel with insertional Achilles tendinitis.
Insertional Achilles tendinitis can occur at any time or activity level, although it is still most common in runners. It is frequently caused by calf muscle tightness, which places increased stress on the Achilles tendon insertion.
Achilles tendinitis is typically not related to a specific injury. The problem results from repetitive stress to the tendon. This often happens when we push our bodies to do too much, too quickly. Other factors can also make a person more likely to develop Achilles tendinitis, including:
- A sudden increase in the amount or intensity of exercise activity. For example, increasing the distance you run every day by a few miles without giving your body a chance to adjust to the new distance may cause irritation and inflammation.
- Tight calf muscles. Calf muscle tightness puts extra stress on the Achilles tendon, especially where it inserts into the heel bone.
- Haglund's deformity. This is a condition in which there is enlargement of the bone on the back of the heel. This can rub on the Achilles tendon and cause inflammation and pain.
Common symptoms of Achilles tendinitis include:
- Pain and stiffness along the Achilles tendon in the morning
- Pain along the tendon or back of the heel that worsens with activity
- Severe pain the day after exercising
- Thickening of the tendon
- Bone spur formation (insertional tendinitis)
- Swelling that is present all the time and gets worse throughout the day or with activity
- Pain on the back of the heal when you wear shoes
If you have experienced a sudden pop in the back of your calf or heel, you may have torn your Achilles tendon.
Achilles Tendinitis Management
Do I need imaging?
X-rays provide clear images of bones. They can show bone spurs on the back of the heel, which may be present in patients with insertional Achilles tendinitis. In cases of severe noninsertional Achilles tendinitis, X-rays may show calcification in the middle portion of the tendon.
Although magnetic resonance imaging (MRI) is not necessary to diagnose Achilles tendinitis, it is important for planning surgery if nonsurgical treatment is not effective. An MRI scan can show the severity of the damage in the tendon. If surgery is needed, an MRI is helpful to determine the extent of tendon damage.
Do I need surgery?
The mainstays of nonsurgical treatment include anti-inflammatory pain medications, activity modification, shoe wear modification, and physical therapy exercises.
Surgery for Achilles tendinitis should be considered only if the pain does not improve after 6 months of nonsurgical treatment. The specific type of surgery depends on the location of the tendinitis and the amount of damage to the tendon.