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, Tendinosis, 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. 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.
The causes of Achilles tendonitis all appear to be related to excessive stress being transmitted through the tendon. Weak calf muscles, poor ankle range of motion, and excessive pronation have all
been connected with the development of Achilles problems.The upshot is that all of these factors, plus training volume and so on, result in damage to the tendon. Much like a bungee cord is made up of
tiny strands of rubber aligned together, tendons are comprised of small fiber-like proteins called collagen. Pain in the Achilles tendon is a result of damage to the collagen. Because of this,
treatment options should start with ways to address this.
Symptoms of Achilles tendinitis and tendinosis include recurring localized heel pain, sometimes severe, along the achilles tendon during or after exercise. Pain often begins after exercise and
gradually worsens. Morning tenderness or stiffness about an inch and a half above the point where the Achilles tendon is attached to the heel bone. Sluggishness in your leg. Mild to severe swelling.
Stiffness that generally diminishes as the tendon warms up with use.
On examination, an inflamed or partially torn Achilles tendon is tender when squeezed between the fingers. Complete tears are differentiated by sudden, severe pain and inability to walk on the
extremity. A palpable defect along the course of the tendon. A positive Thompson test (while the patient lies prone on the examination table, the examiner squeezes the calf muscle; this maneuver by
the examiner does not cause the normally expected plantar flexion of the foot).
Tendinitis usually responds well to self-care measures. But if your signs and symptoms are severe or persistent, your doctor might suggest other treatment options. If over-the-counter pain
medications - such as ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve) - aren't enough, your doctor might prescribe stronger medications to reduce inflammation and relieve pain. A physical
therapist might suggest some of the following treatment options. Exercises. Therapists often prescribe specific stretching and strengthening exercises to promote healing and strengthening of the
Achilles tendon and its supporting structures. Orthotic devices. A shoe insert or wedge that slightly elevates your heel can relieve strain on the tendon and provide a cushion that lessens the amount
of force exerted on your Achilles tendon.
If several months of more-conservative treatments don't work or if the tendon has torn, your doctor may suggest surgery to repair your Achilles tendon.
Your podiatrist will work with you to decrease your chances of re-developing tendinitis. He or she may create custom orthotics to help control the motion of your feet. He or she may also recommend
certain stretches or exercises to increase the tendon's elasticity and strengthen the muscles attached to the tendon. Gradually increasing your activity level with an appropriate training
schedule-building up to a 5K run, for instance, instead of simply tackling the whole course the first day-can also help prevent tendinitis.