Achilles tendinitis is a common overuse injury that affects the Achilles tendon, the band of tissue that connects the calf muscles at the back of the lower leg to your heel bone. It typically occurs in runners who have suddenly increased the intensity or duration of their runs. Middle-aged people who play sports, such as tennis or basketball, only on the weekends are also at higher risk of this condition.
Anatomy and Function of the Achilles Tendon
The Achilles tendon is the largest and strongest tendon in the body. It facilitates walking by helping to raise the heel off the ground. Despite its strength, the Achilles tendon is prone to tendinitis due to its limited blood supply and the significant stresses placed on it during physical activities.
Causes and Risk Factors
Achilles tendinitis is often caused by repetitive or intense strain on the tendon. Common causes include:
Sudden Increase in Activity: Jumping into an intense workout regime without proper conditioning can strain the tendon.
Improper Technique: Poor training techniques or wearing inappropriate footwear can contribute to excessive stress on the tendon.
Tight Calf Muscles: Limited flexibility in the calf muscles increases the strain on the Achilles tendon during movement.
Bone Spurs: Extra bone growth where the tendon attaches to the heel can irritate the tendon, leading to tendinitis.
Risk factors for developing Achilles tendinitis include age, as the tendon weakens with time, and gender, with men being more prone to the condition. Other factors include obesity, which places more strain on the tendon, and certain medical conditions like high blood pressure and psoriasis.
Symptoms
The primary symptom of Achilles tendinitis is pain and stiffness along the Achilles tendon, typically in the morning or after periods of rest. This pain may decrease with activity but then worsen with prolonged or intense exercise. Other symptoms include:
Swelling along the tendon or at the back of the heel.
Thickening of the tendon.
Limited range of motion when flexing the foot.
A creaking or crackling sound (crepitus) when moving the ankle.
Diagnosis
Diagnosing Achilles tendinitis involves a thorough medical history and physical examination. A doctor will look for signs of tenderness and swelling along the tendon. They may ask the patient to perform specific movements to gauge the pain and flexibility. Imaging tests, such as X-rays, ultrasound, or MRI, might be used to confirm the diagnosis and rule out other conditions, like a tendon tear.
Treatment
Treatment for Achilles tendinitis typically begins with conservative methods aimed at reducing pain and inflammation, promoting healing, and preventing further damage. These treatments include:
Rest and Activity Modification: Reducing or stopping activities that aggravate the condition is crucial. Low-impact exercises, such as swimming or cycling, can help maintain fitness without stressing the tendon.
Ice Therapy: Applying ice packs to the affected area can reduce swelling and pain. Ice should be applied for 15-20 minutes several times a day.
Medication: Over-the-counter pain relievers, such as ibuprofen or naproxen, can help manage pain and inflammation.
Physical Therapy: Stretching and strengthening exercises are essential in treating The Foot & Ankle Clinic. Eccentric strengthening exercises, which involve slowly lowering the heel after raising it, are particularly effective. A physical therapist can also provide guidance on proper techniques to avoid future injuries.
Orthotics and Supportive Devices: Shoe inserts or orthotic devices can help alleviate stress on the Achilles tendon. In some cases, a doctor may recommend wearing a walking boot or using crutches to allow the tendon to heal.
Extracorporeal Shock Wave Therapy (ESWT): This non-invasive procedure uses shock waves to stimulate healing within the tendon. It is typically considered when other treatments have not been effective.
Surgical Intervention
If conservative treatments fail after several months, surgical intervention might be considered. Surgical options depend on the severity of the tendinitis and the presence of any associated conditions, such as bone spurs. Procedures can range from removing the damaged portion of the tendon to lengthening the calf muscles to reduce stress on the tendon.
Prevention
Preventing Achilles tendinitis involves adopting several key practices:
Gradual Increase in Activity: Gradually increase the duration and intensity of your workouts to avoid overloading the tendon.
Proper Footwear: Wear shoes that provide adequate support and cushioning. Replace worn-out shoes regularly.
Stretching and Strengthening: Regularly perform exercises to strengthen the calf muscles and improve flexibility.
Cross-Training: Include a variety of low-impact activities in your fitness routine to avoid repetitive strain on the tendon.
Conclusion
Achilles tendinitis is a painful condition that can significantly impact one’s ability to perform physical activities. However, with early diagnosis and appropriate treatment, most people can recover fully and return to their regular activities. Maintaining good physical habits and being mindful of the signs and symptoms can help prevent this condition and ensure the health and functionality of the Achilles tendon.
