Achilles Tendinitis

Definition

Achilles tendinitis is present when your Achilles tendon becomes inflamed or irritated.

Often, Achilles tendinitis results from sports that place a lot of stress on your calf muscles and Achilles tendon, such as basketball. Achilles tendinitis also is often associated with a sudden increase in the intensity or frequency of exercise.

When treated promptly, Achilles tendinitis is often short-lived. Left untreated, Achilles tendinitis could cause persistent pain or cause your tendon to tear (rupture). If so, you may need surgery to correct the damage.

Fortunately, rest and over-the-counter medications to reduce your pain and inflammation may be all the treatment you need for Achilles tendinitis.

Symptoms

The signs and symptoms of Achilles tendinitis often develop gradually. They include:

• Dull ache or pain when pushing off your foot during walking or when rising on your toes
• Tenderness over your Achilles tendon
• Stiffness that lessens as your tendon warms up
• Mild swelling or a "bump" on your tendon
• A crackling or creaking sound when you touch or move your Achilles tendon

You may notice that the affected tendon is sore when you get up in the morning or after you've rested, improves slightly once you start moving around, and then worsens again when you increase your activity level.

If you have sudden pain and swelling near your heel and are unable to bend your foot downward or walk normally, you may have ruptured your Achilles tendon. If you've ruptured the tendon completely, you won't be able to rise on your toes on the injured leg. You may feel as if you've been kicked in the back of your ankle. See your doctor immediately if you suspect you have an Achilles tendon rupture.

Causes

Your Achilles tendon is the large band of tissues connecting the muscles in the back of your calf to your heel bone. Also called the heel cord, the Achilles tendon is used when you walk, run, jump, or push up on your toes.

When you place a large amount of stress on your Achilles tendon too quickly, it can become inflamed from tiny tears that occur during the activity. A sudden increase in a repetitive activity that involves the Achilles tendon can be to blame. A number of other factors can cause Achilles tendinitis, including:

• Improper conditioning. Achilles tendinitis is most common among athletes whose bodies aren't properly conditioned for their sport or activity. Inadequate flexibility and strength of the calf muscles can contribute to overload of the tendon. Frequent stops and starts during the activity, as well as activities that require repeated jumping — such as basketball or tennis — also can increase your risk of Achilles tendinitis.
• Too much, too soon. Achilles tendinitis resulting from overuse can occur when you begin a new exercise regimen. If you're just beginning a new exercise program, be sure to stretch before and after exercising, and start slowly, increasing your activity over time. Don't push yourself too quickly. If you're a runner, excessive hill running can contribute to Achilles tendinitis.
• Flattened arch. Flattening of the arch of your foot (excessive pronation) can place you at increased risk of developing Achilles tendinitis. This is because of the extra stress placed on you Achilles tendon when walking. If you have excessive pronation, be sure to wear shoes with appropriate support to avoid further aggravating your Achilles tendon.
• Trauma or infection. In some cases, inflammation of the Achilles tendon is due to trauma or infection near the tendon.

When to seek medical advice

If you experience pain around your Achilles tendon that worsens with activity, call your doctor for an evaluation and to discuss treatment options.

See your doctor if you experience persistent pain near the back of your heel in the area of your Achilles tendon, and especially if the pain doesn't markedly improve within one to two weeks despite self-care measures. See your doctor immediately if you experience signs or symptoms of an Achilles tendon rupture.

Tests and diagnosis

To diagnose Achilles tendinitis, your doctor will examine your foot and may have an X-ray taken of the area to rule out other causes of your pain. He or she will also ask questions about your physical activity.

If your doctor suspects that your Achilles tendon has torn, he or she may order an MRI scan, a painless procedure that uses magnetic fields to create a computer image of the soft tissues of your body.

Complications

Achilles tendinitis can progress to a degenerative condition called Achilles tendinosis, in which the tendon begins to lose its organized structure, making the tendon weaker and more fibrous. Continued stress to your Achilles tendon could cause it to tear (rupture), which may require surgery to correct the damage

Treatments and drugs

If you've tried self-care measures, such as rest, ice and over-the-counter pain relievers, and they aren't working for you, your doctor may suggest other Achilles tendinitis treatments:

• Orthotic devices. A temporary foot insert (orthotic device) that elevates your heel within your shoe may relieve strain on the stretched tendon. Your doctor also might prescribe special heel pads or cups to wear in your shoes to cushion and support your heel, or a splint to wear at night that will keep the Achilles tendon stretched while you sleep.
• Boot and crutches. In severe cases, your doctor may suggest a walking boot or have you use crutches to enable the tendon to heal.
• Surgery. Nonsurgical treatments, including physical therapy and perhaps a change in your exercise program, should allow the tendon to heal and repair itself over a period of weeks. If these treatments aren't effective, surgery to remove the inflamed tissue from around the tendon may be necessary; however, this is usually a last resort.

If left untreated and if the tendon continues to sustain small tears through exercise and repeated movement, the tendon can rupture under excessive stress.

Prevention

While it may not be possible to prevent Achilles tendinitis, you can take measures to reduce your risk:

• Increase your activity level gradually. If you're just beginning an exercise regimen, don't feel like you have to be marathon-ready in record time. Starting slowly will help you determine your limits and follow a sensible exercise program.
• Take it easy. Avoid activities that place excessive stress on your tendons, especially for prolonged periods. If you participate in a strenuous activity, warm up first by exercising at a slower pace. If you notice pain during a particular exercise, stop and rest.
• Choose your shoes carefully. The shoes you wear while exercising should provide adequate cushion for your heel and should have a firm arch support to help reduce the tension in the Achilles tendon. Replace shoes that show excessive wear. If your shoes are in good condition but don't support your feet, try arch supports in both shoes.
• Stretch daily. Take the time to stretch your calf muscles and Achilles tendon in the morning, before exercise and after exercise to maintain flexibility. This is especially important to avoid a recurrence of Achilles tendinitis.
• Strengthen your calf muscles. Performing exercises such as toe raises, especially with a slow return to the ground after each toe raise, trains the muscle-tendon unit to withstand more loading force.
• Cross-train. Alternate impact activities, such as running and jumping, with low-impact activities, such as cycling and swimming.

Lifestyle and home remedies

If you think you may have Achilles tendinitis, help speed your recovery and prevent further problems by trying these at-home care methods:

• Rest. Avoid activities that increase the pain or swelling. Don't try to work or play through the pain. Rest is essential to tissue healing. But this doesn't mean complete bed rest. You can do other activities and exercises that don't stress the injured tendon, especially low-impact activities, such as bicycling.
• Ice. To decrease pain, muscle spasm and swelling, apply ice to the injured area for up to 20 minutes, several times a day. Ice packs, ice massage or ice water slush baths all can help. For an ice massage, freeze a plastic foam cup full of water so that you can hold the cup while applying the ice directly to the skin.
• Compression. Because swelling can result in loss of motion in an injured joint, compress the area until the swelling has ceased. Wraps or compressive elastic bandages are best.
• Elevation. Raise the affected ankle above the level of your heart to reduce swelling. It's especially important to use this position at night.

Keep moving
Although rest is a key part of treating tendinitis, prolonged inactivity can cause stiffness in your joints. Move the injured ankle through its full range of motion and perform gentle Achilles tendon stretches to maintain joint flexibility.

Anti-inflammatory medications
You can also try nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen (Advil, Motrin, others) or products containing acetaminophen (Tylenol, others) to try to reduce the discomfort associated with tendinitis.

Be sure to talk to your doctor if you feel you need NSAIDs for an extended time because some of these drugs should be used for only short periods — around seven to 10 days — to avoid complications.

If you take NSAIDs frequently or take more than the recommended dose, these medications can cause stomach pain, stomach bleeding and ulcers. Rarely, prolonged use can disrupt normal kidney function. If you have liver problems, talk to your doctor before using products containing acetaminophen.