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Achilles Tendonitis

Symptoms of Achilles Tendonitis:

  • Pain behind the heel
  • Pain after a period of inactivity
  • Stiffness, soreness or tenderness in the tendon (directly above the heel to just below the calf muscle)
  • The area above the heel is tender to the touch
  • Enlarged tendon

The largest tendon in the human body is the Achilles tendon. It connects the back of the heel to the calf muscle. It is a large, cord-like structure, and Achilles tendonitis is a common injury for athletes.

Achilles tendonitis tends to occur more frequently in older athletes than in younger athletes. As a person ages, the ligaments and tendons of the body tend to lose some of their elasticity and strength. As a result, older individuals who are active in running and jumping activities are more prone to tendon injuries such as Achilles tendonitis. However, Achilles tendonitis can also occur in teenagers who are very active in running and jumping sports. When the Achilles tendon is overused, it can become inflamed, which can lead to pain and swelling of the ankle. 

A related condition, Achilles tendonosis, is a result of untreated Achilles tendonitis. Sometimes degeneration involves the location where the tendon connects to the heel bone. In rare, chronic degeneration, cases it is possible that a rupture of the tendon will result.

Causes of these conditions:

Achilles tendonitis is an overuse disorder typically caused by a sudden increase of activity (commonly with repetitive movements). Microscopic tears occur, and if the activity causing the injury is continued the tears will not heal.

Most commonly, people with supination (meaning they tend to walk on the outside of their foot) are prone to these conditions. Also, people with a flattening of the arch or excessive pronation are more likely to develop Achilles tendonitis and tendonosis. This is because there is a greater demand on the Achilles tendon when walking with these conditions. Wearing proper supportive footwear is important to promote healing and avoid future injuries.

There are two main causes of Achilles tendonitis: lack of flexibility and over-pronation. However, it can be caused by other factors as well. Recent changes in footwear and changes in exercise routines can contribute to the development of Achilles tendonitis.

Diagnosis of Achilles Tendonitis:

The doctors of the Washington Heel Pain Center will evaluate the current condition and range of motion of the tendon. Imaging devices, such as ultrasound imaging, may be used to evaluate the state of the tendon. Achilles tendonitis is diagnosed by a history and physical examination of the patient who describes pain at the back of the ankle with walking and/or running activities. The pain from Achilles tendonitis is often so severe that running is impossible and even walking is uncomfortable. Achilles tendonitis may cause the tendon to be thickened in areas, may cause swelling of the area around the tendon, and can even feel like the tendon has a painful bump on it. In addition, the person with Achilles tendonitis will limp while barefoot, but walk more normally with heeled shoes on.

Treatment Options for Achilles Tendonitis

Early treatment is always best. Achilles tendonitis generally responds very well to conservative treatment as long as it is diagnosed and treated early. The degree of damage and the length of time you have been experiencing these conditions determine which treatment options are available. In the early stages or during a sudden inflammation, treatments can include ice, rest, anti-inflammatories, special splints or braces.

Is Surgery Necessary?

Surgery may be necessary when non-surgical techniques do not restore the tendon. After evaluating the extent of the injury we will recommend the appropriate procedure to repair the tendon. Surgery is rarely indicated unless the Achilles tendonitis is particularly severe and chronic, or if the tendon has ruptured completely.