Achilles tendonitis, also sometimes called Achilles tendinitis, is a painful and often debilitating inflammation of the Achilles tendon (heel cord). The Achilles tendon is the largest and strongest tendon in the body. It is located in the back of the lower leg, attaches to the heel bone (calcaneus), and connects the leg muscles to the foot.
The Achilles tendon gives us the ability to rise up on our toes, facilitating the act of walking, and Achilles tendonitis can make walking almost impossible.
There are three stages of tendon inflammation:
- Peritenonitis with tendinosis
Peritenonitis is characterized by localized pain during or following activity. As this condition progresses, pain often develops earlier on during activity, with decreased activity, or while at rest.
Tendinosis is a degenerative condition that usually does not produce symptoms (i.e., is asymptomatic). It may cause swelling or a hard knot of tissue (nodule) on the back of the leg.
Peritenonitis with tendinosis results in pain and swelling with activity. As this condition progresses, partial or complete tendon rupture may occur.
Incidence and Prevalence
The overall incidence of Achilles tendonitis is unknown. The condition occurs in approximately 6–18% of runners, and also is more common in athletes, especially in sports that involve jumping (e.g., basketball), and in people who do a lot of walking.
Achilles tendonitis that occurs as a result of arthritis in the heel is more common in people who are middle aged and older.
Risk Factors and Causes
Poorly conditioned athletes are at the highest risk for developing Achilles tendonitis, also sometimes called Achilles tendinitis. Participating in activities that involve sudden stops and starts and repetitive jumping (e.g., basketball, tennis, dancing) increases the risk for the condition. It often develops following sudden changes in activity level, training on poor surfaces, or wearing inappropriate footwear.
Achilles tendonitis may be caused by a single incident of overstressing the tendon, or it may result from a series of stresses that produce small tears over time (overuse).
Patients who develop arthritis in the heel have an increased risk for developing Achilles tendonitis. This occurs more often in people who middle aged and older.
The condition also may develop in people who exercise infrequently and in those who are just beginning an exercise program, because inactive muscles and tendons have little flexibility because of inactivity. It is important for people who are just starting to exercise to stretch properly, start slowly, and increase gradually.
In some cases, a congenital (i.e., present at birth) condition causes Achilles tendonitis. Typically, this is due to abnormal rotation of the foot and leg (pronation), which causes the arch of the foot to flatten and the leg to twist more than normal.
Signs and Symptoms
In most cases, symptoms of Achilles tendonitis, also sometimes called Achilles tendinitis, develop gradually. Pain may be mild at first and worsen with continued activity. Repeated or continued stress on the Achilles tendon increases inflammation and may cause it to rupture. Partial or complete rupture results in traumatic damage and severe pain, making walking virtually impossible and requiring a long recovery period.
Patients with tendinosis may experience a sensation of fullness in the back of the lower leg or develop a hard knot of tissue (nodule)
Treatment for Achilles tendonitis, depends on the severity of the injury. If heel pain, tenderness, swelling, or discomfort in the back of the lower leg occurs, physical activity that produces the symptoms should be discontinued.
If the problem returns or persists, a medical professional should be consulted. If pain develops even with proper stretching and training techniques, the patient should consult a podiatrist to check for hyperpronation and adequate arch support. The addition of an orthotic may be enough to maintain good arch and foot alignment and eliminate pain.
If damage to the tendon is minor, the injury may respond to a simple course of treatment known as RICE (rest, ice, compression, elevation).
Patients are advised to:
- rest the tendon by keeping off their feet as much as possible;
- apply ice packs for 20 minutes at a time every hour for a day or two to reduce swelling;
- compress the ankle and foot with a firmly (not tightly) wrapped elastic bandage; and
- elevate the foot whenever possible to minimize swelling.
A nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen may be used to reduce pain, swelling, and inflammation.
If this sounds like something that you are suffering from give Footfit Podiatry Tauranga a call and we will be happy to help