What Is Tendonitis?
Tendonitis is the general term for any condition in which a tendon becomes irritated and inflamed. Achilles tendonitis is a foot and ankle condition that specifically affects the Achilles tendon, which runs down the back of the lower leg and connects the calf muscle to the heel bone.
Pain and discomfort that is caused by Achilles tendonitis can often be treated effectively by a doctor known as a podiatrist who specializes in podiatry, or foot and ankle problems.
Achilles tendonitis and Achilles tendonosis are two common disorders that affect the heel cord.
In Achilles tendonitis, the Achilles tendon is inflamed. Inflammation caused by this condition is typically short-lived. However, when not treated, Achilles tendonitis can progress to Achilles tendonosis, which is degeneration of the tendon.
In Achilles tendonosis, the tendon loses its structure and develops microscopic tears. In some instances, degeneration can affect the site where the Achilles tendon attaches to the heel bone to cause a heel spur or ruptured tendon.
What Causes Achilles Tendonitis?
Achilles tendonitis and tendonosis are usually caused by overuse and repetitive activities—such as running—that involve the Achilles tendon. Repetitive activity can put excess stress on the Achilles tendon and injure its fibers. When this happens too quickly, the body is unable to effectively repair the injured tissue, which can alter the structure of the tendon to cause chronic pain.
This foot condition tends to be more common among athletes and people whose work puts stress on the feet and ankles. It also affects people with excessive pronation—or flattening of the arch. Without stable, properly fitting shoes, overpronation may further aggravate the Achilles tendon.
What Are Symptoms of Achilles Tendonitis?
The primary symptom of Achilles tendonitis is a mild ache in the back of the leg or above the heel that occurs after activities like running.
Other symptoms of Achilles tendonitis include:
- Stiffness or tenderness in the tendon upon waking
- Pain or tenderness when the sides of the Achilles tendon are squeezed
- Enlargement of the tendon, or the development of nodules in the area
How Is Achilles Tendonitis Diagnosed and Treated?
Achilles tendonitis or tendonosis can be diagnosed with a physical examination of the foot and ankle. Imaging tests such as X-ray, Ultrasound or MRI may be performed to assess the severity of the condition.
Treatments for Achilles tendonitis or tendonosis are usually based on the length of time the injury has been present and on the severity of damage to the tendon. These treatments include:
- Immobilization of the Achilles tendon using a cast or removable walking boot to promote healing
- Ice to reduce swelling and inflammation for 20 minutes at a time
- Oral medications, particularly nonsteroidal anti-inflammatory drugs like ibuprofen
- Custom orthotic devices for those with overpronation or gait abnormalities
- Night splints help the Achilles tendon stay stretched during sleep
- Physical therapy, which may include strengthening exercises, soft-tissue massage, and stretching
When Is Surgery Needed?
Surgery may be needed for Achilles tendonitis or tendonosis when nonsurgical treatments fail to restore the tendon to its normal condition or the tendon is torn. A podiatrist can recommend the best procedure for repairing the tendon based on factors including the severity of the injury and the patient’s age and activity level.
How Can Achilles Tendonitis Be Prevented?
Achilles tendonitis cannot always be prevented. However, certain behaviors may reduce the risk of developing this injury.
Ways to prevent Achilles tendonitis include:
- Starting out slowly with a new exercise routine and gradually increasing the intensity level
- Stretching the calf muscles and Achilles tendon regularly
- Wearing comfortable, supportive, properly fitting shoes