Achilles tendonitis is a common condition affecting one of the largest tendons in the body. The tendon connects the calf muscles to the heel bone and is vital in the function of walking, running, climbing stairs, jumping, and standing on tiptoes. Tendonitis occurs when the tendon becomes acutely inflamed and irritated. Tendinopathy is often associated with this condition, described as microscopic degeneration due to chronic damage over a period of time. There are two distinct types of Achilles tendonitis, insertional and non-insertional tendonitis. Unfortunately, the two types of Achilles tendonitis can occur separately or succinctly. Non-insertional Achilles tendonitis is characterized by inflammation of the fibers in the middle portion of the tendon, above the attachment to the heel bone. Whereas, insertional Achilles tendonitis involves the lower portion of the tendon as it attaches to the heel bone. The tendon fibers may calcify over time and bone spurs can form on the back of the heel.
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Symptoms
The symptoms associated with Achilles tendonitis include pain and stiffness along the Achilles tendon particularly first thing in the morning, pain along the back of the heel that worsens with activity, and thickening of the tendon. Bone spur formation, chronic swelling and pain with shoe wear are also signs and symptoms of tendonitis. Non-insertional Achilles tendonitis is more often found in younger, and active patients. When there is palpation pain in the middle of the tendon for non-insertional or at the back of the heel bone for insertional, it’s associated with limited range-of-motion in your ankle.
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Causes
Achilles tendonitis, unlike Achilles ruptures, is not usually related to a specific injury. Repetitive stress to the tendon, such as over exertion is the most common cause. Other factors that contribute to the development of Achilles tendonitis include tight calf muscles, haglund’s deformity, or a sudden increase in the intensity or amount of exercise.
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Treatment
Treatment for Achilles tendonitis is aimed at providing pain relief and reducing inflammation. Anti-inflammatory medication, such as ibuprofen, or prescription medication may be used to reduce the inflammation within the tendon. Initial treatment may include rest, icing, footwear modification, orthotics, stretching/physical therapy and oral medications. Physical therapy is aimed at stretching and strengthening the calf muscles and reducing stress on the Achilles tendon. A Pedorthist can fit and dispense a night splint, which holds the foot in place while in a calf stretch position while you sleep. Maintaining healthy calf flexibility will not only help treat Achilles tendonitis but will aid in preventing recurrent issues. Supportive footwear with an open back or soft heel may help to reduce the shearing and irritation of the tendon during healing. A pneumatic walking boot may be necessary for severe pain and inflammation, often a period of non-weight bearing is necessary to reduce the strain to the tendon. More advanced therapies such as extracorporeal shockwave therapy have shown to promote healing of the damaged tendon.
