Achilles tendinitis is an overuse injury of the Achilles tendon. The Achilles tendon is the thick band of tissue that connects your calf muscles to your heel bone. Types of overuse includes increasing speed or running long distances too quickly, suddenly adding hills or stair climbing to an exercise routine, stressing the calf muscle too soon after taking time off from exercising, or putting stress on the calf muscles when they are not yet ready for stress.
Achilles tendinitis can be common in all ages but is more common in older adult men due to the fact that the tendon weakens as we age, and also in young athletes due to repetitive stress and strain from intensive training. Other risk factors include poor flexibility, lack of range of motion, inverted foot structure, obesity/diabetes, poor exercise training program, poor footwear, or increased use of corticosteroids. There are two types of Achilles tendonitis:
- Insertional Achilles tendonitis which affects the lower portion of your tendon where it attaches to your heel bone.
- Noninsertional Achilles tendonitis which involves fibers in the middle portion of the tendon and tends to affect younger people who are active.
The pain associated with Achilles tendinitis typically begins as a mild ache in the back of the leg or above the heel after increased activity. Stiffness and tenderness can also occur with decreased use of the extremity. For example, an individual may experience stiffness with weight bearing when getting out of bed due to inactivity. People may also have difficulty wearing shoes due to increased swelling around the tendon site.
The most common treatment for acute tendinitis would be supportive care with rest and ice. This means stopping the activities that make pain worse and placing ice on the area that is inflamed and painful multiple times a day. Ankle taping to support the tendon has also been shown to be a helpful at home remedy. If pain persists and lingers, another option would be non-steroidal anti-inflammatory medication to assist with reducing pain and swelling. Physical therapy is a common route to take with both acute and chronic cases of Achilles tendinitis. Soft tissue mobilization and calf stretching are common treatments in physical therapy. There are also methods that have been proven helpful like cupping and dry needling. These can be performed on the tendon site if other conservative methods haven’t done the job.
Extracorporeal shockwave therapy can be used to stimulate healing. This is not a very common procedure and it has not shown consistent results. This is normally implemented on chronic cases of tendonitis when all conservative methods listed above have failed. ESWT uses high energy shockwave impulses to stimulate the healing process in damaged tendon tissue. It is a non-invasive procedure and is occasionally tried before surgery is considered.
If pain persists for more than 6 months after all conservative treatments, then surgery should be considered. The specific type of surgery will depend on the location of the tendinitis and the amount of damage to the tendon. Physical therapy is recommended after an Achilles tendon surgery and is an important part of recovery. Many patients require a year of rehab from start to finish before they are pain free.
Prevention of Achilles tendinitis can be taken in many ways. First, by wearing proper footwear that allows cushioning and arch support. Second, by slowly increasing activities and easing into new routines. And lastly, making it a priority to stretch and strengthen your calf muscles daily to improve agility and make the tendon less prone to injury.