Achilles tendinitis

Definition

Achilles tendinitis is inflammation, irritation, and swelling of the Achilles tendon (the tendon that connects the muscles of the calf to the heel).

Alternative Names

Tendinitis of the heel

Causes, incidence, and risk factors

There are two large muscles in the calf: the gastrocnemius and the soleus. These muscles generate the power for pushing off with the foot or going up on the toes. The large Achilles tendon connects these muscles to the heel.

These are important muscles for walking. This tendon can become inflamed, most commonly as a result of overuse or arthritis, although inflammation can also be associated with trauma and infection.

Tendinitis due to overuse is most common in younger individuals and can occur in walkers, runners, or other athletes, especially in sports like basketball that involve jumping. Jumping places a large amount of stress on the Achilles tendon.

Tendinitis from arthritis is more common in the middle-aged and elderly population.

Symptoms

Symptoms usually include pain in the heel when walking or running. The tendon is usually painful to touch and the skin over the tendon may be swollen and warm.

Signs and tests

The doctor will perform a physical exam and look for tenderness along the tendon and for pain in the area of the tendon when you stand on your toes.

Imaging studies can also be helpful. X-rays can help diagnose arthritis, and an MRI will show inflammation in the tendon.

Treatment

Treatment usually involves:

• Ice
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen
• Rest
• Physical therapy

You should limit any activities that make the symptoms worse.

Occasionally, a cast, brace, or boot may be used to keep the heel still and allow the swelling to go down.

If these treatments fail to improve symptoms, surgery may be needed to remove inflamed tissue and abnormal areas of the tendon.

Expectations (prognosis)

Conservative therapy usually helps improve symptoms. However, symptoms may return if activities that cause the pain are not limited, or if the strength and flexibility of the tendon is not maintained.

Surgery, if needed, has been shown to be very effective in improving pain symptoms.

Complications

Achilles tendinitis may make you more likely to have an Achilles rupture. This condition usually causes a sharp pain, like someone hit you in the back of the heel with a stick. Surgical repair is necessary, but difficult because the tendon is not normal.

Calling your health care provider

If you have pain in the heel around the Achilles tendon that is worse with activity, contact your health care provider for evaluation and possible treatment for tendinitis.

Prevention

Prevention is very important in this disease. Maintaining strength and flexibility in the muscles of the calf will help reduce the risk of tendinitis. Overusing a weak or tight Achilles tendon makes you more likely to develop tendinitis.