Achilles Tendonitis - Dr. Jeffrey E McAlister

Achilles Tendonitis

Achilles Tendonitis

Achilles Tendonitis is a common condition that occurs when the large tendon that runs from the calf down to the heel bone becomes irritated and inflamed. The Achilles is the largest tendon in the body and is used for various physical activities such as walking, running, sprinting, jumping, etc. Although the Achilles tendon can withstand great stress, it is particularly prone to develop inflammation, which is a condition often linked to overuse and degeneration. Thus, placing long distance runners and sprinters in particular at increased risks.

There are two types of Achilles tendonitis:

  • Midsubstance or NonInsertional Achilles Tendonitis – Occurs in the middle portion of the tendon
  • Insertional Achilles Tendonitis – Occurs where the large tendon connects to the heel bone.

Symptoms, Causes or Risk Factors, and Treatment Options for Achilles Tendonitis

Symptoms of Achilles Tendonitis

Common symptoms of Achilles Tendonitis may include:

  • Pain – Aching, stiffness, or soreness within the Achilles tendon. This pain may transpire anywhere from the calf to the heel. This pain is likely to worsen in the morning or when exercise activity is increased.
  • Tenderness – This can be moderate to potentially severe pain when the two sides of the tendon are squeezed versus directly touched.
  • Bone Spur (insertional tendonitis) – Nodule(s) behind the damaged tissue may form when the disorder progresses to degeneration.
  • Tendon Thickening – Thickening of the Achilles tendon.

Causes or Risk Factors for Achilles Tendonitis

Achilles tendonitis is generally not caused by a specific injury but is instead an ailment caused by repetitive stress on the Achilles tendon. This repetitive stress occurs when a person pushes in an exercise or sport too much within a short amount of time, commonly known as an “overuse injury,” placing too much stress too quickly on the Achilles. However, there are other risk factors that may cause Achilles tendonitis to develop, such as a:

  • Bone growth or spur – Extra bone growth where the tendon attaches to the heel, which can rub against the tendon and cause pain.
  • Tight calf muscle(s) – Having tight calf muscles and abruptly starting an aggressive exercise program.

Treatment Options for Achilles Tendonitis

Treatment Options for Achilles Tendonitis

There are several non-surgical treatment options for Achilles tendonitis:

  • Immobilization – One option is immobilization, which may include the use of a cast or removable brace that will promote healing.
  • Ice – Applying ice for 20 minutes on and off may help to reduce the inflammation and swelling of the tendon. Note, however, the ice should not be placed directly on the skin.
  • Medications – Oral medications such as nonsteroidal anti-inflammatory medications (NSAIDs) are useful in reducing swelling and inflammation as well. Ibuprofen is a popular choice.
  • Shoe Orthotics or Inserts – These may be beneficial especially for those who suffer from overpronation, which is caused by uneven body weight distribution pressing down on the foot, or gait abnormalities.
  • Night Splints – These may be used at night to maintain a stretch in the Achilles tendon during sleep.
  • Physical Therapy (PT) – Stretches and exercises specific to rehabilitation of the Achilles tendon.
  • Platelet-Rich Plasma or Stem Cell Injections – Injections to assist in decreasing the inflammation and reboot the healing phase may be helpful.

Surgical Treatment Options for Achilles Tendonitis

If non-surgical treatment options have been exhausted, surgery to repair the tendon may be considered. The operation chosen may depend on the extend of the condition, as well as the person’s age and activity level.

Surgery for Midsubstance or Noninsertional Achilles Tendonitis

For midsubstance or noninsertional Achilles tendonitis, surgery will focus on removing the bad portion of the tendon. If the tendon is damaged, a surgeon will often use the tendon that goes to the big toe to support the Achilles tendon. If the Achilles tendon or calf muscles are too tight, surgery may also focus on lengthening them.

Surgery for Insertional Achilles Tendonitis

In this surgery, diseased tissue is often removed. The tendon is then repaired back down to the heel bone. The surgeon may shave down the bone spur and smooth it out. This prevents the bone spur from rubbing the Achilles tendon and irritating it. Often a fluid-filled sac called a “bursa” is a contributing factor to pain and inflammation. In these cases, the bursa is removed during surgery

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