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Achilles tendinitis is an overuse injury of the band of tissue that joins your calf muscles at the back of your lower leg to your heel bone, known as the Achilles tendon.
Achilles tendinitis most frequently affects runners who have abruptly increased their run length or intensity. Middle-aged people who only participate in weekend sports like basketball or tennis are also prone to this.
Most occurrences of Achilles tendinitis can be managed with relatively straightforward at-home treatment while under the guidance of your doctor. Self-care techniques are typically required to stop reoccurring episodes. Achilles tendon ruptures (tendon tears) can result from more severe occurrences of Achilles tendinitis and may need to be repaired surgically.
Symptoms
After jogging or engaging in other physical activity, Achilles tendinitis pain frequently starts as a minor soreness at the back of the leg or above the heel. When running, climbing stairs, or sprinting for an extended period of time, more intense pain episodes may happen.
Tenderness or stiffness may also be present, especially in the morning, but this normally goes away with light exercise. Swelling may also appear around the Achilles tendon.
Call your doctor if the area around your Achilles tendon is painful all the time. In the event that the pain or disability is severe, seek immediate medical attention. You might have an Achilles tendon tear or rupture.
Causes
The band of tissue that connects your calf muscles to your heel bone, the Achilles tendon, is subjected to repeated or severe strain, which results in Achilles tendinitis. When you walk, run, leap, or lift yourself up onto your toes, this tendon is affected.
Age-related structural weakening of the Achilles tendon makes it more prone to injury, especially in persons who do sports exclusively on the weekends or who have abruptly increased the intensity of their running routines.
Risk factors
Your chance of developing Achilles tendinitis may be impacted by a number of variables, including:
- Sex. Men are more likely than women to get Achilles tendinitis.
- Age. As you get older, Achilles tendinitis becomes increasingly prevalent.
- Physical problems. Your foot’s inherent flat arch may place more stress on your Achilles tendon. Additionally, calf muscle tightness and obesity might worsen tendon strain.
- Physical activities. Achilles tendinitis risk is increased when running in worn-out shoes. Cold weather is more likely than warm weather to cause tendon soreness, and running on mountainous terrain increases your risk of Achilles injury.
- Underlying diseases. Achilles tendinitis is more likely to occur in those with psoriasis or hypertension.
- Medications. Fluoroquinolones, a class of antibiotics, have been linked to greater occurrences of Achilles tendinitis.
Diagnosis
Your doctor will lightly touch on the affected area during the physical examination to pinpoint the site of any pain, soreness, or swelling. Additionally, your foot and ankle’s flexibility, alignment, range of motion, and reflexes will be assessed.
Imaging tests
To evaluate your condition, your doctor may request one or more of the tests listed below:
- X-rays. Although X-rays cannot see soft structures like tendons, they can help exclude other illnesses that can cause comparable symptoms.
- Ultrasound. In order to see soft tissues like tendons, this instrument uses sound waves. The Achilles tendon can also be seen moving in real time with ultrasound, and color-Doppler ultrasonography can measure blood flow around the tendon.
- Magnetic Resonance Imaging (MRI). MRI machines are capable of creating detailed images of the Achilles tendon using radio waves and a powerful magnet.
Treatment
Self-care techniques are typically effective for tendinitis. However, if your symptoms are severe or persistent, other treatment options could be advised by your doctor.
Medications
Your doctor may prescribe stronger medications to reduce inflammation and alleviate pain if over-the-counter pain relievers like ibuprofen or naproxen are ineffective.
Physical therapy
The following are some possible treatments that a physical therapist might advise:
- Exercises. To encourage healing and strengthening of the Achilles tendon and its supporting components, therapists frequently recommend particular stretches and strengthening activities.
It has been discovered that “eccentric” strengthening, a unique sort of training that involves slowly lowering a weight after raising it, is very beneficial for chronic Achilles issues.
- Orthotic devices. The Achilles tendon can be spared stress by using a shoe insert or wedge that lifts your heel just enough to soften the force being applied to it.
Surgery
Surgery to repair your Achilles tendon may be recommended by your doctor if several months of more conservative therapies have failed or if the tendon has ripped.
These are the surgical techniques:
- Gastrocnemius recession: The calf muscles (gastrocnemius) are lengthened by the surgeon.
- Debridement and repair: If the majority of the tendon is still healthy, the surgeon only removes the diseased portion while stitching the remaining healthy tendon together. You’ll need to wear a boot or cast for a few weeks after the treatment.
- Debridement with tendon transfer: A sufficient amount of healthy Achilles tendon is required for function. If more than half of it is injured, an Achilles tendon transfer is required. The tendon that aids in the big toe’s downward pointing is removed by the surgeon and moved to the heel bone. The injured tendon becomes strong enough to function after treatment. You’ll be able to walk, run, and even move your big toe. However, following this operation, you might not be able to play sports competitively.
- Hydrocision TenJet: High velocity saline is used in this minimally invasive, ultrasound-guided procedure to dissolve tendon scar tissue. On an outpatient procedure, the pressurized saline acts as blade to selectively remove unhealthy tissue.
