Foot & Ankle

Achilles Tendinitis

Anatomy

The foot is a complex, flexible structure that contains bones, joints, and more than 100 muscles, tendons and ligaments, all working together to enable movement and balance. The foot is divided into three sections, the forefoot, the midfoot and the hindfoot, which includes the ankle and heel. The heel bone (calcaneus) is the largest bone in the foot.

Tendons are bands of tissue that attach muscle to bone. The largest tendon in the body is the Achilles tendon. The Achilles tendon connects the calf muscles to the heel bone, allowing movement such as running, jumping and standing on the toes.

Description

Inflammation is the body's natural response to injury, disease, overuse or degeneration, and it often causes swelling, pain, or irritation. Inflammation of a tendon is called tendinitis. Achilles tendinitis is a common condition that causes pain along the back of the leg, near the heel. Although the Achilles tendon can withstand great stresses from running and jumping, it is also prone to tendinitis.

Causes

Below are some of the most common causes of Achilles tendinitis.

• Stress—Excessive or repetitive stress to the Achilles tendon can produce inflammation that results in tendinitis.
• Sudden increase in amount or intensity of exercise activity—For example, increasing the distance you run every day by a few miles without giving your body a chance to adjust to the new distance.
• Tight calf muscles—Having tight calf muscles and suddenly starting an aggressive exercise program can put extra stress on the Achilles tendon.
• Bone Spur—Extra bone growth where the Achilles tendon attaches to the heel bone can rub against the tendon and cause pain.

Symptoms

Common symptoms of Achilles tendinitis include:

• Pain and stiffness along the Achilles tendon in the morning.
• Pain along the Achilles tendon or back of the heel that worsens with activity.
• Severe pain the day after exercising.
• Thickening of the tendon.
• Bone spur (insertional tendinitis).
• Swelling that is always present and worsens throughout the day with activity.

Nonsurgical Treatment

In most cases, nonsurgical treatment options will provide pain relief, although it may require a few months for symptoms to completely subside. Even with early treatment, the pain of Achilles tendinitis may last longer than 3 months. If appropriate, a foot and ankle conditioning program may be recommended. Nonsurgical treatment may include:

• Rest—Discontinue participation in athletic activities and avoid walking on the injury.
• Ice—Apply ice several times a day to help reduce swelling and pain..
• Nonsteroidal anti-inflammatory medication (NSAIDs)—Drugs such as ibuprofen or naproxen may help relieve pain, inflammation and swelling. Most people are familiar with nonprescription NSAIDs such as aspirin and ibuprofin, however, whether using over-the-counter or prescription strength, they must be used carefully. Using these medications for more than one month should be reviewed with your primary care physician. If you develop acid reflux or stomach pains while taking an anti-inflammatory, be sure to talk to your doctor.
• Eccentric strengthening protocol—Contracting (tightening) a muscle while it is getting longer.
• Supportive shoes and orthotics—Pain from insertional Achilles tendinitis is often lessened by wearing appropriate shoes and orthotic devices.
• Platelet-rich plasma (PRP)—A relatively recent treatment option, PRP therapy, is currently being studied by researchers and is considered by some to hold promise for certain injuries. Contact your orthopaedic surgeon to find out if this treatment would be appropriate for you.

Surgery

Surgical treatment to relieve Achilles tendinitis should only be considered if pain does not improve after 6 months of nonsurgical treatment.

• Gastrocnemius recession—This is a surgical lengthening of the calf (gastrocnemius) muscles.
• Debridement and repair—The goal of this surgery is to remove the damaged part of the Achilles tendon. During the procedure, the unhealthy portion of the tendon is removed and the remaining tendon is repaired with sutures (stitches). Most patients are allowed to walk in a removable boot or cast within 5 weeks following surgery, however, this may vary depending upon the amount of damage to the tendon.

With any surgery there are some risks, and these vary from person to person. Complications are typically minor, treatable and unlikely to affect your final outcome. Your orthopaedic surgeon will speak to you prior to surgery to explain any potential risks and complications that may be associated with your procedure.