Achilles Tendinitis is a very common running injury but is also known to make an appearance in basketball players, dancers, or people in general who apply a lot of repeated stress on their feet. It can be a very painful condition. The Achilles Tendinitis is an overtime injury (like Shin Stress Fracture) that is caused due to a minor tear (or major rupture) in the Achilles tendon. The pain is similar to that of a hit or a kick in the back of the leg.
Table of Content:
- Anatomically Speaking: The Achilles Tendon
- What is Achilles Tendinitis
- How Does Achilles Tendinitis Happen
- Achilles Tendinitis and Other Conditions Defined
- The Causes of Achilles Tendinitis
- Symptoms and Indicators of Achilles Tendinitis
- How Is Achilles Tendinitis Diagnosed
- Achilles Tendinitis Treatment
- How Long Does Achilles Tendinitis Last
- Summing Up
Anatomically Speaking: The Achilles Tendon
The Achilles tendon is a large tendon at the back of the ankle. It is an extension of the gastrocnemius and soleus (calf muscles), running down the back of the lower leg attaching to the calcaneus (heel bone). The Achilles tendon affixes the leg muscles to the foot and gives the propensity to push off during walking and running.
What is Achilles Tendinitis
If the Achilles tendon becomes painful, swollen, stiff or irritated due to overuse, it can lead to the condition known as Achilles Tendinitis. This condition is thought to be caused due to repeated tiny injuries, known as micro trauma, to the Achilles tendon. Post each injury the complete healing of the tendon does not take place as it should, which means that, over time, the damage to the Achilles tendon builds up. If this further goes untreated, it can lead to a chronic/ongoing condition that makes simply walking around almost impossible.
The uncompromising definition of the term tendonitis points towards an inflammatory condition of the tendon, but practically, few injuries are known to be solely due to inflammations. Technically speaking, Achilles Tendinopathy is probably a wiser term that encompasses the range of conditions that cause pain in the Achilles tendon. For instance, it’s found that in the case of older athletes, the cause is mainly the degeneration of the tendon.
How Does Achilles Tendinitis Happen
There are two large muscles in the calf, which are responsible for creating the power needed to push off with the foot or to go up on your toes. The large Achilles tendon is the one that connects these muscles to the heel.
Tendons are tough bands of tissue that connect muscles to bones. The Achilles tendon, being one of the longest tendons in the body, is essential for activities such as walking and running. These continuous daily activities make it susceptible to significant wear and tear. An Achilles tendon can either partly tear or rupture entirely. In the case of a partial tear, symptoms are similar to Tendinopathy while a complete rupture will present pain and sudden loss of strength and movement.
Achilles Tendinitis and Other Conditions Defined
There are various tendon conditions that can cause Achilles tendon pain. For ease of understanding we have explained them below in brief:
Tendonitis is inflammation of the tendon. Achilles Tendinitis is usually an acute or a quick-onset condition which can last up to 6 weeks or less. Few practitioners diagnose this as the first in a continuum of tendon injuries that in due course increases in severity.
Tendinosis is a non-inflammatory deterioration of the tendon, which typically materializes due to long-term overuse of the tendon, leading to weakening of the tendon fibres.
Paratenonitis is inflammation or swelling of the tissue that surrounds the tendon, which may thicken and adhere to the tendon. This diagnosis stands controversial, as many practitioners do not accept paratenonitis to be any different from tendonitis.
Insertional Achilles Tendinopathy
Insertional Achilles Tendinopathy is inflammation, and later, degradation of the tendon fibres that insert on the back of the heel bone/calcaneus. While many doctors describe these conditions as being a part of the spectrum of Achilles tendinopathy, others tend to use the term tendinopathy loosely to denote a tendon which fails to heal. Anyone who has been diagnosed with Achilles tendinopathy is advised to enquire about the details of their condition.
The Causes of Achilles Tendinitis
Achilles tendinitis can advance in disparate ways. There are a few pointers that are easier to avoid than others, and being aware can aid in earlier diagnosis and help prevent serious injury.
Insertional Achilles tendonitis is not necessarily activity related. This condition will affect the lower portion of the tendon as it inserts into the heel bone. Now, non-insertional Achilles tendonitis is more common among younger and more active people. In this case, the fibres in the middle of the tendon start to break down, thicken, and swell.
Causes of Achilles tendinitis include:
- The use of incorrect or worn out shoes during exercising or running.
- Not performing proper warm up before an exercise.
- Incorporating intensity of exercise too quickly, like say, running speed or amount of distance covered.
- Introduction of hill running or stair climbing into an exercise routine prematurely.
- Running on hard or uneven surfaces.
- Any sudden intense physical activity. For instance, sprinting for the finish line.
- An injured calf muscle with little flexibility, will increase the strain on the Achilles tendon
- A difference in anatomy of the foot, leg, or ankle, such as flat feet or fallen arches could also lead to applying strain on the tendon.
- Extra bone growths or bone spurs where the tendon joins the bone, can rub against the Achilles tendon, causing damage and discomfort.
Just as an additional side note, patients who are taking fluoroquinolone antibiotics may run a higher risk of tendinitis and tendon rupture. The danger of injury does not disappear when the dosage stops, and people have reported tendon problems even several months after they stopped using the drug.
Symptoms and Indicators of Achilles Tendinitis
Most cases of Achilles Tendonitis start out slowly with very little pain, leading to a gradual build-up of pain that worsens over time.
A person suffering from this condition will also notice the following:
- The Achilles tendon will feel sore a few cm above where it meets the heel bone.
- Some swelling or hard knots of tissue in the Achilles tendon.
- The lower leg feels stiff, slow, or weak.
- There is stiffness and tenderness in the heel, especially during the mornings, which gradually goes away.
- A slight pain occurs in the back of the leg after running or exercising and becomes more severe.
- Pain that intensifies when walking uphill, climbing stairs, or taking part in any intense or prolonged exercises.
- The Achilles tendon shows signs of swelling or forms a bump.
- The Achilles tendon creaks or crackles when the ankle is touched or moved or pressed.
- The affected leg shows weakness.
You can decide the grade of pain in your Achilles tendon using this table:
Grade of Pain
Pain post running only.
Pain prior to and post running; pain might show a gradual decrease during a run.
Pain accompanying an activity; leading to decrease in volume of activity.
Pain during everyday activities; pain worsening or progressing.
These and many other similar symptoms show up in a number of conditions, therefore it is encouraged to seek medical advice for accurate diagnosis.
How is Achilles Tendinitis Diagnosed
If you feel you are suffering from Achilles Tendinitis, get a check-up from your doctor before the situation worsens. Your doctor will ask you questions about the activities you've been doing and will examine your leg, foot, ankle, and knee for range of motion.
In case your pain is more severe, the doctor may check to see you haven’t ruptures or torn your Achilles tendon. In order to check this, the doctor will have you lay down face down, and bend your knee whilst pressing your calf muscles to see if the foot flexes. Any flexing of the foot will indicate that the tendon is at least partly intact.
They may also ask you to perform some other exercises to put some stress on your Achilles tendon. For instance, standing on the affected leg and raising your heel off the ground, or hopping on that foot whether on the spot or in a forward direction. These kinds of movement assist the diagnosis by bringing on or reproducing the pain.
It's also a possibility that the doctor might order an X-ray or MRI scan of your foot and leg so as to check for fractures, partial tears of the tendon, or signs of a condition that might get worse. An X-ray will show whether the lower part of the Achilles tendon has calcified which is a clear denotation of Achilles tendonitis.
In the case of severe noninsertional Achilles Tendinitis, calcification can occur in the middle portion of the tendon as well. An MRI while not necessary for diagnosing the condition, assists in showing the severity of the damage to the tendon and hence helps in planning for surgery.
Achilles Tendinitis Treatment
Treatment aims to relieve pain and reduce swelling. The possible course of action of the treatment will be conditional as per the severity of the condition and whether the patient is a professional athlete or not. The doctor will in all likelihood recommend a combination of strategies.
The prompt treatment of any soft tissue injury is composed of the RICE protocol which stands for – Rest, Ice, Compression and Elevation. This method should be followed for 48–72 hours. The main aim is to reduce the damage within the joint.
Another method is the No HARM protocol which is – No Heat, No Alcohol, No Running (or activity) and No Massage. This protocol will have similar effects of reducing the swelling in the injured area.
Methods of treating Achilles tendinitis include:
- Application of Ice packs to the tendon, when in pain or after exercising, can diminish the pain and inflammation.
- Resting gives the tissue time to heal. The type of rest would depend on the severity of the symptoms, in mild cases, it could mean reducing the intensity of a workout, but severe cases might require complete rest for days or weeks.
- Elevating the foot above the level of the heart can reduce swelling.
- Exercise and stretching, physical therapy taught by a therapist can improve flexibility and increase calf strength. This would also help the Achilles tendon to heal and prevent future injury. Physical therapy is mostly more effective for non-insertional Achilles tendinitis.
- Pain relief via medications of the likes of non-steroidal, anti-inflammatory drugs - NSAIDS can reduce pain and swelling. However, people suffering from asthma, kidney disease, or liver diseases should first check with their doctor.
- Steroid injections, like Cortisone can reduce tendon swelling, but has also been associated with a greater risk of tendon rupture. What can reduce the risk is giving the injection while scanning the area with ultrasound.
- Compression bandages and orthotic devices such as ankle supports, shoe inserts and Achilles tendon braces can aid recovery as they take the stress off the tendon.
- Extracorporeal shockwave therapy or ESWT is the use of high-energy shockwaves to stimulate the healing process. While the results have not shown consistency, in case other measures fail, it’s worth a try before opting for surgery.
How Long Does Achilles Tendinitis Last
It usually takes between a few days to 6 weeks or a month or two, for tendonitis to heal depending on the severity of the injury.
About 1 in 4 people who have persevering pain have surgery to treat the condition.
Surgery would involve either of the following:
- Discarding nodules or adhesions -parts of the fibres of the tendon that have stuck together, that have developed within the damaged tendon.
- Making a lengthways cut in the tendon to help to invigorate and boost tendon healing.
- While complications from surgery aren’t common, should they occur, can include issues with wound healing.
This condition cannot be completely prevented, but the dangers of developing it can be lowered by foreseeing the possible causes and taking precautions:
- Create a variation in exercise methods to alternate between high impact exercises like running and low impact exercises like swimming which will reduce the stress on the tendon on some days.
- Wear correct shoes that support the arch and protect the heel and replace them when worn out.
- In case you have a shoe of good condition but doesn’t provide the necessary arch support, use artificial arch supports inside the shoe.
- Gradually increase the intensity of a workout since Achilles Tendinitis can occur when the tendon suddenly undergoes too much strain.
- Stretching and warming up helps to keep the Achilles tendon flexible, reducing the chances of tendonitis developing. Stretch every day, including on your rest days to further improve flexibility.
- In most cases, change in lifestyle can help to improve symptoms. However, remember that symptoms could return if you do not restrict activities that induce pain, or if you do not sustain the power and flexibility of the tendon.
Achilles Tendinitis can affect anyone, but it’s a point to be noted that individuals with higher activity levels are more at risk, especially individuals who frequently partake of activities that include running and jumping. You could steer clear of Achilles tendon pain with the proper measures. Even if you encounter minor Achilles tendon pain, it is necessary to rehabilitate your injury and not continue to push yourself.
Repetitive action on an already painful Achilles tendon may lead to the rupture of the tendon, necessitating further medical intervention. If you show any of the signs of Achilles Tendinitis it is best to reach out to a doctor at the earliest to discuss treatment options. They might be able to recommend small lifestyle changes, or in case of severe circumstances interventional treatment options can be offered.
Even if you do get Achilles Tendonitis, don’t get discouraged, get better, get up, and run again!