Achilles Tendonitis
People who are active or play sports may develop problems with their Achilles tendons. When patients experience pain in the back of their heel or lower leg, they usually seek medical advice to deal with pain and swelling.
Dr. Stern has provided quality podiatric care in Vancouver for over 30 years and has experience diagnosing and treating Achilles disorders. Below is a brief guide explaining Achilles tendonitis, its causes, and possible treatments.
What Is the Achilles Tendon?
Tendons are thick bands of tissue that connect bones to muscles. The Achilles tendon or heel cord connects the calf muscles to the back of the heel bone. The body engages the tendon whenever a person lifts their feet off the ground to walk, run, stand on their toes, and climb stairs.
Named after Achilles of Greek mythology, the strongest hero of the Trojan War, the Achilles tendon is the body’s strongest tendon. It’s also the largest, so it can withstand a significant amount of pressure and weight, enabling people to jump and run.
Despite the strength of the heel cord, it is possible to overwork the tendon. Too much stress can result in Achilles tendon disorders, including tendinitis.
What Are Disorders of the Achilles Tendon?
When people overuse their Achilles tendons, they could develop a disorder within the tissue. The two most common types are Achilles tendonitis and Achilles tendonosis.
Though these disorders often affect people who frequently engage in physical activity, it is possible for those who lead a less active lifestyle to have complications with their heel cords. Any repetitive strain from sudden acceleration or deceleration in movement, like running, can lead to degenerative changes in the fibers connecting the heel to the calf.
What Causes Achilles Tendon Disorders?
The primary cause of Achilles tendon disorders is the overuse of the band of fibers. For instance, jogging every day or pushing oneself too much in any activity that involves the Achilles tendon can lead to Achilles tendonosis or tendonitis.
Overworking the tendon can cause micro-injuries of its fibers. Continuing to work the tendon prevents the body from repairing the injured tissue. As a result, a person may experience persistent pain on the back of the heel going up to the calf because the tendon’s structure changes to accommodate the injury.
What Is Achilles Tendonitis?
Achilles tendonitis is one of the most common heel cord disorders that podiatrists treat. Tendonitis is the inflammation of a tendon, so Achilles tendonitis refers to an inflamed Achilles tendon. Inflammation is the body’s natural way to fight against viruses, disease, and injury, but it can cause pain and discomfort.
People can develop two types of tendonitis. Noninsertional Achilles tendonitis is when fibers in the tendon’s middle begin to degenerate due to multiple tiny tears. The injuries cause the tendon to swell and thicken.
Noninsertional Achilles tendonitis is more common in active young people, while insertional Achilles tendonitis, the second most common heel cord disorder, usually occurs in mature adults after years of overuse. Insertional tendonitis affects the lower part of the heel where its bone meets the tendon. Though anyone can develop the disorder, long-distance runners and sprinters usually have it.
Both types of Achilles tendonitis can lead to calcification, which is the hardening of injured tendon fibers. The hardening can lead to bone spurs or extra bone growths.
Causes of Achilles Tendonitis
Unlike other heel cord disorders, Achilles tendonitis doesn’t require a specific type of physical activity or injury to develop. It comes from repetitively stressing the tendon by pushing the body into motion too often or too soon after a foot, ankle, or calf injury.
Some factors increase the risk of developing Achilles tendonitis, such as increasing the frequency or intensity of physical activity. For example, starting a high-intensity workout routine without resting days between sessions can overstress the tendon.
Tight calf muscles are another contributing factor to the disorder. If these muscles are too rigid due to a rigorous exercise regime targeting that muscle group, it could decrease the tendon’s natural flexibility.
Symptoms of Achilles Tendonitis
A person with Achilles tendonitis could experience pain and stiffness on the back of their heel. The pain is more prominent in the morning when they attempt to stand and walk after several hours in bed, not engaging their heel cord. Heel cord pain could also worsen with physical activity or after a day of exercising.
Other symptoms of this Achilles disorder are persistent swelling, bone spurs, and noticeable tendon thickening.
Without treatment, Achilles tendonitis could result in a tendon rupture. A sudden “pop” sound or feeling in the back of the calf or heel may accompany the tear. A torn Achilles tendon will require immediate evaluation from a podiatrist or ER.
Diagnosing Achilles Tendonitis
When visiting Dr. Stern’s clinic to treat chronic heel pain, he will first discuss your symptoms and recent activity. If they suspect an Achilles disorder is the cause of the pain, they will conduct a thorough check and order tests to diagnose the condition.
Physician Examination
After Dr. Stern listens to your concerns, he will carefully examine both feet and ankles. Some of the symptoms they will look for to determine if Achilles tendonitis is the cause of the discomfort include:
Inability to flex the foot
Bony spurs on the lowest part of the tendon
Inflammation along the back of the heel
Enlargement of the tendon
Pain and tenderness around the back of the ankle or heel
X-Rays
If ordered, an x-ray imaging allows a closer look at the foot, ankle, and lower leg bones. The images show whether the tendon has calcification, indicating insertional Achilles tendonitis. X-rays can also show whether the patient has an advanced form of insertional Achilles tendonitis, which can cause the tendon’s middle portion to harden as well as the lower half.
Ultrasound
Ultrasound is a safe and painless way of using sound waves for Dr. Stern to look at the muscles, tendons, ligaments, nerves, and joints of your foot and ankle. The technology works on a principle similar to that used in sonar, which helps submarines navigate, and echolocation, which allows bats to see their surroundings even on moonless nights.
Ultrasound has many applications, from diagnosing injuries such as muscle tears and chronic conditions, including rheumatoid arthritis, to guiding podiatrists through diagnostic and therapeutic procedures. No radiation or injectable contrast agent is needed.
Magnetic Resonance Imaging (MRI)
If there are concerns for a tear or lack of improvement, an MRI scan may be ordered to understand a person’s heel tendon issues better. An MRI is an imaging technique that produces detailed computer-generated photos of a patient’s organs and tissues.
A medical professional may use MRI images to show the extent of a person’s tendon damage. It helps determine if the patient needs surgery or if nonsurgical treatments are enough to repair the tendon damage.
Who is at Risk for Achilles Tendon Disorders?
Anyone can develop an Achilles tendon disorder, but they are most common in people who play sports, run, dance, or work in environments that put a lot of stress on their feet and ankles.
People with specific bodily shapes and structures may be prone to Achilles tendonitis. For example, the disorder is common in people with flat foot arches, rolling ankles, and tight or weak calf muscles.
Treatment
It is possible to heal from Achilles tendon disorders, but it will take time. In most cases, people can use nonsurgical treatments over several months to reduce or eliminate the pain.
However, severe cases, such as torn Achilles tendons, may require surgery to repair the damage.
Rest
The most crucial step in treating tendonitis is to rest the affected body part. Treating Achilles tendonitis means staying off the affected foot as much as possible. People with the condition can also switch to low-impact physical activities like swimming to reduce stress on the tendon.
Ice
Ice can reduce inflammation in muscles and tissues. If inflammation produces too much pain, icing the tendon for up to 20 minutes can reduce the discomfort.
Medication
Nonsteroidal anti-inflammatory drugs or NSAIDs from a local pharmacy are another way to treat the pain. These over-the-counter drugs reduce inflammation and treat pain, allowing people to move without discomfort.
Exercise
Some exercises can work out the calf muscles without putting undue stress on the Achilles tendon. A calf stretch is one of the best options.
To do the exercise, lean forward on a wall, straighten the knee, and keep the heel on the ground. Put the other leg in front of the extended leg and bend the knee. Push the hips forward toward the wall to safely stretch the calf muscle and Achilles tendon.
Orthotics
Supportive shoes and orthotic devices, and possibly a heel lift, can ease the pain from insertional Achilles tendonitis. They may reduce irritation to the tendon or take away some of its strain while flexing the foot.
Dr. Stern Will Help You Get Back on Your Feet
Dr. Joseph Stern is a foot and ankle specialist with over 30 years of experience and offers a broad range of advanced orthopedic and non-surgical treatment options for Achilles tendon issues.
Working out of their Vancouver office, our doctor and his team offer the highest level of care to address Achilles problems and help you return to your daily activities.
Schedule an appointment today if you’re ready to better understand your treatment options.
