Achilles Tendonitis: Causes, Symptoms, Treatment and prevention
What is Achilles tendonitis?
Achilles Tendonitis is inflammation of the achilles tendon and typically affects active people, it is considered an overuse injury. The achilles tendon is an extension of the calf muscle and is responsible for attachment of the calf to the heel bone. It is the largest tendon in the body and has very limited blood flow, which can make it difficult to heal.
Achilles tendonitis can vary in severity, it can be divided into one of three levels;
- Mild – At this point the pain only presents during a certain activity, for example running.
- Moderate – At the moderate level, the pain will present more regularly and there may be some swelling in the tendon. A hard nodule may also appear on the back of the heel.
- Severe – At the severe level, the pain can be almost unbearable and occurs with any weight bearing activity. Sometimes the achilles tendon can tear, if this occurs surgery will be needed to repair the tendon.Regardless of the level, achilles tendinitis can become debilitating quite quickly and requires prompt medical advice and treatment from a professional.
Causes and risk factors of achilles tendonitis
Achilles Tendonitis is caused by overload and overuse. Overuse of the tendon causes micro-tears, which can become quite painful.
- Physical activity – Certain sports and/or physical activities can place a greater load on the achilles tendon. Achilles tendonitis is most common among runners and sports which involve agile and plyometric style movements (jumping), such as basketball and netball. Once the tendon becomes inflamed it is recommended that running and jumping are limited to allow healing.
- Exercise surface – Uneven surfaces can cause inflammation and lead to pain and swelling of the achilles tendon.
- Age – As we age we are more likely to experience achilles tendinopathy.
- Your sex – Achilles tendinopathy is more commonly seen in males than females.
- Biomechanics (the way you move) can also contribute to inflammation of the achilles tendon. A pronated foot posture (or a flat foot) can place extra stress on the plantar fascia, this then places a further load on both the calves and the achilles tendon. Your Podiatrist may recommend orthotics to correct your foot posture.
- Footwear choices can also contribute to inflammation in the achilles tendon. Footwear that is well worn or provides little support can place unnecessary stress on the structures of the foot, causing degenerative changes to the achilles tendon. Wearing heels regularly can encourage shortening of the tendon.
- Obesity or a significant/sudden increase in weight is considered a high risk factor for achilles tendinopathy.
- Some medications have been associated with achilles tendinopathy. In particular antibiotics called quinolones. There have been many cases where patients on these antibiotics have experienced an achilles rupture soon after beginning the course.
- Tightness in the calf muscles has also been known to contribute to achilles tendinitis.
Symptoms of Achilles tendonitis
Some symptoms you may experience with achilles tendinopathy include;
- Pain anywhere in the tendon, but usually on the back of the heel. Usually at worst in the morning or after rest.
- Difficulty walking along with stiffness in the ankle
- Tightness in the tendon
- Swelling and heat specific to the tendon
If you notice any of these symptoms please seek medical advice as fast as possible.
Diagnosing achilles tendonitis
How is achilles tendonitis diagnosed? First of all, your Podiatrist will conduct a thorough history and physical examination. If achilles tendinopathy is suspected, your Podiatrist will send you for radiology – Usually ultrasound and X-ray, but an MRI can also detect the presence of inflammation.
Treating achilles tendonitis
How can achilles tendonitis be treated? The aim of the treatment is to reduce the load going through the tendon, this can be done in many ways, including;
RICE method – Rest, Ice, compression, elevation
- Rest or reduction in activity is crucial for healing the achilles tendon, however, in most cases it is still necessary to have some loading through the tendon to encourage strengthening.
- Icing the affected area, icing the tendon can help to address any inflammation.
- Compression can help to increase blood flow to the area. This can be done with an ankle sleeve or compression sock.
- Elevation, After a long day of standing it can be useful to elevate the affected limb to encourage a decrease in inflammation.
Pain medication – usually Ibuprofen is used to decrease pain and inflammation.
Strengthening exercises – thorough and specific stretching and strengthening program will be prescribed by your Podiatrist or Physiotherapist to address any tightness and strength deficits in the muscles surrounding the foot and ankle. The specific program is based around eccentric calf raises as research has deemed these the most beneficial to the healing of achilles tendonitis. As the tendon begins to heal, the program is adapted to include more complex exercises to allow the tendon to get used to a larger load.
Shockwave therapy – shockwave therapy is a method of treatment used to stimulate the healing response by an increase in blood flow to the affected area. Usually patients will have between 4 and 6 sessions, but this will depend on the success of the treatment as well as the severity of the condition.
Dry needling – Dry needling is a treatment method in which very fine needles are placed into the skin to access deep myofascial trigger points (in this case in the calves). The dry needling can help to decrease tension in the muscle, increasing the range of motion and therefore take strain off the achilles tendon.
Strapping, sometimes strapping of the foot might be used to temporarily alter foot posture and encourage healing through offloading of the tendon.
Orthotic therapy can be used to redistribute the plantar pressures in the foot and therefore offload the painful tendon.
Heel lifts – often used to offload the tendon. These are a device that can be placed in the shoe to lift the heel up and therefore take the load off the achilles. However, heel lifts can only be used as a temporary solution as they shorten the tendon when used for a prolonged period of time.
Surgery for achilles tendonitis is usually only performed if all other conservative treatment methods have been exhausted and unsuccessful. As with any surgery, there are risks associated.
Recovery from Achilles tendonitis
Unfortunately, recovering from achilles tendon injuries is often a lengthy process. Length of recovery will depend on the severity of the condition and compliance to the treatment plan. Recovery from achilles tendonitis will be prolonged if the tendon is not rested and offloaded. There is also the risk of an achilles tendon rupture of the condition is not managed properly and carefully.
If the treatment plan is followed closely and accurately, you should be able to return to your pre-tendinitis state and very gradually return to activity. Usually the recovery takes 12 – 16 weeks.
Preventing Achilles tendonitis
While it may be difficult to prevent achilles tendinitis, we have a few suggestions that may reduce your risk;
- Always make sure you do an adequate warm up and cool down when you exercise or play sport
- Try to avoid increasing exercise frequency, duration or intensity dramatically
- Ensure you are wearing correctly fitted and supportive footwear
- Maintain a healthy body weight, as an increase in weight or a high bodyweight can place an extra load on the achilles tendon.
- If you notice any discomfort in your achilles tendon, rest from exercise and seek advice from your Podiatrist immediately.
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