What is Achilles Tendonitis?
Achilles tendon is a strong and large tendon at the back of the ankle that connects the calf muscles to the heel bone. These muscles are essential for standing, walking, running and jumping. The achilles tendon withstands a great deal of stress. Achilles tendonitis refers to the irritation and inflammation of the tendon due to overuse.
There are two types of achilles tendonitis:
- Insertional achilles tendonitis affects the lower portion where the tendon attaches to the heel. This can occur at any age.
- Non-insertional achilles tendonitis and para-tendonitis affect the middle part of the tendon or its surroundings, causing fluid collection, swelling and thickening in the affected areas. This condition is more common among active young people.
Hardening (calcification) of the damaged tendon fibres can occur in both types of achilles tendonitis.
Achilles tendonitis is usually caused by repetitive minor injuries on the affected area or a sudden injury. Risk may increase when there is a lack of warmup stretching or conditioning before exercise or when one takes up certain sports. Achilles tendonitis may be more likely to occur if one:
- Does not wear shoes with good support
- Jumps a lot (such as during basketball games)
- Runs on hard surfaces such as concrete or runs too often
- Suddenly increases the amount or intensity of an activity
- Has very tight (not stretched out) calf muscles
- Suddenly has his/her foot turn in or out
Tendonitis can also occur when a bone spur forms at the back of the heel, which can irritate the achilles tendon and cause pain and swelling. This condition is more common among older people.
The main symptoms of achilles tendonitis are pain and swelling at the back of the heel. One should consult the doctor when the followings happen:
- Become unable to bend the ankle
- Become unable to walk comfortably on the affected side
- Experience swelling of the calf
- Have an injury that causes deformity around the joint
- Develop ankle or heel pain at night or while resting
- Develop ankle or heel pain for longer than a few days
- Experience signs of infection, including fever, redness or warmth
Treatment depends on the cause of the problem, which include:
- Heat pads to relax muscles and stimulate blood flow
- Ice packs to minimise swelling
- Non-steroidal anti-inflammatory drugs (NSAID) to treat pain
- Physiotherapy to increase strength and regain mobility
- Elevation at rest to reduce swelling
- Rest to treat inflammation
- Steroid injections to treat inflammation
- Stretching to loosen the calf muscle
Surgery is usually only offered for recurrent injuries and persistent pain, but it may become necessary if the tendon tears or loose ligaments are found.
Achilles tendinitis may lead to achilles tendon rupture, which causes a sharp pain and sudden weakness. Surgical repair is commonly indicated.