Achilles Tendonitis: Symptoms, Causes & Diagnosis
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Achilles Tendonitis

What is Achilles tendonitis?

Highlights

  1. Excessive exercise or walking commonly causes Achilles tendonitis, especially for athletes.
  2. Symptoms include pain or swelling in the back of your heel.
  3. The RICE method is a common, effective form of treatment for mild cases.

The Achilles tendon attaches your calf muscles to your heel bone, or calcaneus. You use this tendon to jump, walk, run, and stand on the balls of your feet. Continuous, intense physical activity, such as running and jumping, can cause painful inflammation of the Achilles tendon, known as Achilles tendonitis (or tendinitis).

Simple home treatments can help Achilles tendonitis. However, if home treatment doesn’t work, it’s important to see a doctor. If your tendonitis gets worse, your tendon can tear. You may need medication or surgery to ease the pain.

Causes of Achilles tendonitis

Causes

Excessive exercise or walking commonly causes Achilles tendonitis, especially for athletes. However, factors unrelated to exercise may also contribute to your risk. Rheumatoid arthritis and infection are both linked to tendonitis.

Any repeated activity that strains the Achilles tendon can potentially cause tendonitis. Some causes include:

  • exercising without a proper warmup
  • straining the calf muscles during repeated exercise or physical activity
  • playing sports, such as tennis, that require quick stops and changes of direction
  • wearing old or poorly fitting shoes
  • wearing high heels daily or for prolonged durations

Symptoms of Achilles tendonitis

Symptoms

Symptoms include:

  • discomfort or swelling in the back of your heel
  • tight calf muscles
  • limited range of motion when flexing the foot
  • skin on your heel is overly warm to the touch

The main symptom of Achilles tendonitis is pain and swelling in the back side of your heel when you walk or run. Other symptoms include tight calf muscles and limited range of motion when you flex your foot. This condition can also make the skin on your heel feel overly warm to the touch.

Diagnosing Achilles tendonitis

Diagnosis

To diagnose Achilles tendonitis, your doctor will ask you a few questions about the pain and swelling in your heel or calf. Your doctor may ask you to stand on the balls of your feet while they observe your range of motion and flexibility. The doctor also feels around (palpates) the area directly to pinpoint where the pain and swelling are most severe.

Imaging tests may help confirm Achilles tendonitis, but you usually don’t need them. If ordered, the tests include:

  • X-rays, which provide images of foot and leg bones
  • MRI scans, which can detect ruptures and tissue degeneration
  • ultrasounds, which can show tendon movement, related damage, and inflammation

Treating Achilles tendonitis

Treatment

Many treatments are available for Achilles tendonitis, ranging from rest and ibuprofen (Advil) to steroid injections and surgery. Your doctor might suggest:

  • reducing your physical activity
  • very gentle stretching and later strengthening of the calf muscles
  • switching to a different, less strenuous sport
  • icing the area after exercise or when in pain
  • elevating your foot to decrease any swelling
  • wearing a brace or walking boot to prevent heel movement
  • going to physical therapy
  • taking anti-inflammatory medication, such as aspirin or ibuprofen, for a limited time
  • wearing a shoe with a built-up heel to take tension off the Achilles tendon

RICE method

The rest, ice, compression, and elevation (RICE) method is usually effective in treating your Achilles tendonitis right after you’re injured. This method works in the following way:

  • Rest: Don’t put pressure or weight on your tendon for one to two days until you can walk on the tendon without pain. The tendon usually heals faster if no additional strain is placed on it during this time. Your doctor may suggest that you use crutches if you need to go long distances while resting your tendon.
  • Ice: Put ice in a bag, wrap the bag in a cloth material, and place the wrapped bag of ice against your skin. Hold the bag on the tendon for 15 to 20 minutes, then take the bag off to let the tendon warm up again. The ice usually makes inflammation or swelling go down faster.
  • Compression: Place a bandage, athletic tape, or tie an article of clothing around the tendon to compress the injury. This keeps the tendon from swelling too much. But don’t wrap or tie anything too tightly around the tendon, as it can limit blood flow.
  • Elevation: Raise your foot above the level of your chest. Because your foot is higher than your heart, blood returns to the heart and keeps the swelling down. This is easiest to do by lying down and putting your foot on a pillow or other raised surface.

Surgery

In a case where this treatment isn’t effective, surgery may be necessary to repair the Achilles tendon. If the condition worsens and is left untreated, there’s a greater risk of an Achilles rupture, which requires a surgical intervention. This can cause sharp pain in the heel area.

Your doctor may recommend a few options for a tendon rupture surgery based on how severe your rupture is and on whether you’ve had a rupture before. Your doctor may also refer you to an orthopedic surgeon to decide which procedure is best for you.

One method is called open repair. In this surgery, a surgeon makes an incision to open your leg above the heel bone. Then, they sew the two sides of the ruptured tendon back together and close the incision.

In another method, a surgeon makes an incision to open the area on your leg where the rupture happened. Then, they pass needles with sutures through the tendon and the skin and back out through the incision. Finally, they tie the sutures together.

Complications of Achilles tendonitis

Complications Icon

The most common complication of Achilles tendonitis is pain, having trouble walking or exercising, and your tendon or heel bone becoming deformed. You can also experience a complete tear (rupture) of the Achilles tendon. In this case, you’ll usually need surgery to fix the rupture.

One study found that complications such as hematomata (blood swelling and clotting inside tissue) and deep vein thrombosis (blood clot in a deep vein) are possible after a surgery for Achilles tendonitis. Complications can worsen if you don’t follow your doctor’s instructions after an operation. If you continue to put stress or wear on your Achilles tendon after a surgery, your tendon can rupture again.

Recovery and outlook

Outlook

Tendonitis usually goes away after a few days, following rest and proper home treatment (including the RICE method). Recovery takes a lot longer if you continue to put pressure on the tendon or don’t change your exercise habits to prevent another injury or rupture. Chronic, long-term tendonitis can cause worse issues, including insertional tendonitis (tendon inserting itself into the heel bone) and tendinosis (weakening of the tendon).

A tendon rupture or chronic tendonitis may require long-term treatment or surgery. Recovery from surgery can take anywhere from a few weeks to a few months for full recovery. Seeking treatment for your tendonitis or ruptured tendon right away and following your doctor’s instructions is more likely to result in a quicker recovery.

Preventing Achilles tendonitis

Prevention

To lower your risk of Achilles tendonitis, try to:

  • Stretch your calf muscles at the beginning of each day to improve your agility and make your Achilles less prone to injury. Try to stretch before and after workouts. To stretch your Achilles, stand with a straight leg, and lean forward as you keep your heel on the ground.
  • Ease into a new exercise routine, gradually intensifying your physical activity.
  • Combine high- and low-impact exercises, such as basketball with swimming, to reduce constant stress on your tendons.
  • Choose shoes with proper cushioning and arch support. Also make certain the heel is slightly elevated to take tension off the Achilles tendon. If you’ve worn a pair of shoes for a long time, consider replacing them or using arch supports.
  • Reduce the heel size of shoes gradually when transitioning from high heels to flats. This allows the tendon to slowly stretch and increase its range of motion.

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