The Achilles tendon is the largest tendon in the human body. It connects your heel bone to your calf muscles and is used when walking, running, and jumping. Achilles tendonitis occurs when the Achilles tendon becomes inflamed or aggravated. Achilles tendonitis occurs in the middle area of the tendon which is slightly above the heel, and typically affects athletes and younger individuals.
Achilles tendonitis can also occur in anyone, even people who are not active and occurs on the lower portion of the heel. It’s common for this tendon to get injured. It can be mild or moderate and feel like a burning pain or stiffness in that part of your leg. If the pain is severe, your Achilles tendon may be partially torn or completely ruptured.
I tend to fall into the second group these days. My achilles tendonitis usually hurts in the lower portion my heal and migrates from foot to foot depending on if I have been doing yard work or walking around my office.
What is the cause of the pain?
Achilles tendonitis happens when the tendon has been over-stressed or overworked. Usually, this is caused by sports activity. Especially with the amount or intensity of the exercise changes suddenly. Sometimes tight calf muscles with little flexibility, can cause stress to the tendon and overstretch it.
As we age the tendon becomes less flexible. Middle age athletes are more likely to get Achilles tendonitis. Overuse is a big factor seen in runners who are running too many miles too quickly or running uphill. Poor running form cause also cause this type of injury. A bone spur can rub against the tendon causing inflammation and pain as well. Having flat feet can cause Achilles tendonitis by adding extra strain/
Symptoms and Pain
- Pain and stiffness along the Achilles tendon in the morning
- Pain along the tendon or back of the heel that worsens with activity
- Severe pain the day after exercising
- Thickening of the tendon
- Bone spur (insertional tendinitis)
- Swelling that is present all the time and gets worse throughout the day with activity
If you have experienced a sudden “pop” in the back of your calf or heel, you may have ruptured (torn) your Achilles tendon. See your doctor immediately if you think you may have torn your tendon.
Examination by a Doctor
After you have described your symptoms discuss your symptoms with the doctor, they will then examine your foot and ankle. The doctor will look for signs similar to the following:
- Swelling along the Achilles tendon or at the back of your heel
- Thickening/enlargement of the Achilles tendon
- Bony spurs at the lower part of the tendon at the back of your heel (insertional tendinitis)
- The point of maximum tenderness
- Pain in the middle of the tendon
- Pain at the back of your heel at the lower part of the tendon (insertional tendinitis)
- Limited range of motion in your ankle—specifically, a decreased ability to flex your foot
Sometimes the doctor will ask for X-Ray’s and possibly an MRI (Magnetic Response Imaging) to assist in the diagnoses.
How is it treated?
I am not a doctor, so with any treatment, the best source of advice is your doctor. Achilles tendonitis treatments often include RICE rest, ice, compression, and elevation.
- RICE will help reduce inflammation and swelling
- Anti-Inflammatory medications such as ibuprofen and aspirin can be used too. Follow the instructions on the label. Take them with food. Check with your doctor first if you have any allergies, medical problems or take any other medication. If you need them for longer than 7 to 10 days, call your doctor.
- Physical Therapy for calf and heel stretches
- Ankle braces and orthotics which will support the tendon and prevent further injury
- Use a heel lift, that will protect your tendon in your shoe as you recover.
- Cortisone injections (these are rarely recommended as they could lead to a rupture)
- Surgery is not usually recommended until several months of other treatments don’t work.
Physical Therapy Examples
- Calf Stretch – Lean forward against a wall with one knee straight and the heel on the ground. Place the other leg in the front, with the knee bent. Hold the position for 10 seconds and relax.
- Bilateral heel drop – Stand at the edge of a stair, or a raised platform that is stable, with just the front half of your foot on the stair. This position will allow your heel to move up and down without hitting the stair. Lift your heels off the ground then slowly lower your heels to the lowest point possible. Repeat this step 20 times.
- Single leg heel drop – This exercise is performed similarly to the bilateral heel drop, except that all your weight is focused on one leg. This should be done only after the bilateral heel drop has been mastered.
What Happens After Treatment
If your symptoms are mild, then you start to feel better after 2 to 4 weeks of treatment. However, for more severe injuries the healing process could take 2 -3 months. As your condition improves you begin doing exercises to strengthen your calf muscles.
How to prevent it from coming back
In order to prevent Achilles tendonitis from returning, you should do the following:
- Increase your activity level, but do it gradually.
- Take it easy by avoiding activities that place extra strain on the tendon, such as uphill running.
- Choose your shoes wisely, by choosing shoes that you might wear while working out.
- Stretch your calf muscles daily.
- Strengthen your calf muscles.
- Cross train by alternating activities such as running and jumping with lower impact activities like cycling or development.
Achilles tendonitis while a painful and sometimes aggravating injury is treatable. It is important to properly rehab the tendon after you recover from the injury or the injury will return. If you are having Achilles pain, it is important to see a doctor for a checkup. You deserve to feel better and get back to your day-to-day activities. With the right care and treatment plan, you will be back on health feet in no time.