Achilles Tendonitis

Tendons by definition connect a muscle to a bone. The Achilles tendon connects the calf (gastrocnemius) muscle to the heel bone.

Achilles tendonitis is an inflammation of the Achilles tendon. This inflammation is typically episodic initially but can develop into a chronic problem. Over time the chronic condition usually leads to degeneration or micro trauma of the tendon. Often the insertion of the Achilles tendon is the focus and micro tears and thereafter pain, stiffness and swelling. When the disorder progresses to degeneration and micro tears, the tendon may also become enlarged as a consequence of chronic inflammatory changes and damaged tissue.

Achilles tendonitis is categorized as “overuse” injuries and are precipitated by a sudden increase of a repetitive activity involving the Achilles tendon. This repetitive activity leads to micro-injury of the tendon fibers and without appropriate rest the body is unable to repair the injured and inflamed tissue. Chronic inflammation and repetitive trauma will reduce the structural integrity of the tendon and likely cause pain at the site.

The phrase “weekend warrior” is commonly associated with Achilles tendon injury. In the setting of poor conditioning and repetitive stress Achilles tendons are susceptible to strain, inflammation, and/or rupture.

In diagnosing Achilles tendonitis, the patient’s history is most telling along with an exam with reproducible pain at the Achilles insertion, posterior heel, and/or along the tendon. The extent of the condition can be further assessed with x-rays, ultrasound or MRI.

Treatment approaches for Achilles tendonitis is selected on the basis of how long the injury has been present and the degree of damage or degeneration to the tendon.

Initially when there is sudden (acute) inflammation, treatment is focused on immobilization, “deflamming” the area with ice, anti inflammatory medications, and physical therapy, which may include stretching, soft tissue massage, and/or ultrasound therapy. Also heel lifts decrease strain and reduces pain at the Achilles tendon

If non-surgical approaches are ineffective and complete resolution is not attained surgery may be necessary. The foot and ankle surgeon will select the best procedure to repair the tendon.