Achilles tendon disorders and injuries are diagnosed and treated by the Podiatry Division of Premier Medical Group.
Achilles tendon disorders and injuries are diagnosed and treated by the Podiatry Division of Premier Medical Group.
Achilles tendon disorders and injuries come in many forms. The most common include tendonitis, tendinosis, and partial tears or ruptures. These conditions fall under the umbrella term “tendinopathy,” which covers everything from pain and swelling to impaired function.
Achilles tendinopathy is a condition that causes pain, swelling, and stiffness in the Achilles tendon. This tendon joins the heel bone to the calf muscles, which means tendinopathy can impact everyday activities, such as walking. Tendinopathy is often a cumulative condition, meaning it occurs with the buildup of small injuries over time. If the tendon does not have time to heal between injuries, people will experience Achilles pain, both sharp and dull, as well as swelling. It can be mild or moderate and will often feel like a burning pain or stiffness in the lower part of the leg.
Achilles tendon disorders are also characterized by tenderness in the area, especially when the tendon is squeezed from both sides. If the condition progresses, the tendon may degenerate, become enlarged, and/or develop nodules in the area where the tissue is damaged.
Most Achilles tendinopathy symptoms are caused by overuse. Both Achilles tendonitis and Achilles tendinosis are generally caused by an increase in repetitive activity, like running, gymnastics, dance, football, basketball, tennis, or any other sport that includes periods of jogging and sprinting. Injuries often occur when you begin moving suddenly, pushing off and lifting the foot in a way that puts pressure on the ankle. These types of abrupt actions can stress the tendon, especially without rest between periods of high activity. If the body is unable to repair the injured tissue, the structure of the tendon will change, resulting in sharp, continuous pain.
Achilles tendinopathy can also occur in non-athletic situations. Wearing high-heeled shoes, for example, can stress the tendon by creating ongoing tension. Certain medicines, called glucocorticoids, or antibiotics, called fluoroquinolones, are also risk factors for tendinopathy, but this is often in conjunction with lifestyle factors.
Finally, genetic characteristics may be at play in the development of Achilles pain. People with “flat feet,” also called fallen arches, are at a higher risk for developing Achilles tendinopathy. In people with this physical trait, the arch of the foot collapses in every footfall, stretching the muscles and tendons while participating in an activity as simple as walking.
Achilles tendon disorders are diagnosed by a doctor, often a surgeon. The doctor will examine the foot and ankle with several techniques that evaluate the range of motion. They will also ask about recent activity and look for signs, such as swelling on the back of the heel, pain in the back of the heel, a limited range of ankle motion, and an inability for the foot to flex when the calf muscle is pressed. This will inform them of the tendon’s condition.
If the surgeon suspects severe damage, or if your pain is severe, the condition will be further assessed with the use imaging techniques. An ultrasound or MRI scan can assist in the diagnosis of tendinitis through illustrating soft tissues, and an X-ray can rule out other conditions that may cause similar symptoms.
Achilles tendonitis is an overuse condition, meaning it will occur after activity without sufficient rest. Achilles tendonitis describes the irritation, inflammation, and pain of tendon overuse. This is a very common sports injury, often related to running, but it can happen to any person who puts a lot of stress on their feet. The symptoms of Achilles tendonitis can be caused by a wide range of activities:
Achilles tendonitis symptoms are characterized by leg weakness, pain in the lower leg and heel after activity, leg stiffness, swelling in the Achilles tendon area, and/or experiencing pain while climbing stairs or walking uphill. Achilles tendonitis is an acute condition, meaning it is usually both sudden and short-term. It is caused by a direct injury to a tendon. If left untreated, tendonitis symptoms can turn into tendinosis, which is a chronic condition caused by repetitive trauma to the tendon.
In contrast to tendinitis, Achilles tendinosis is a chronic, persisting condition that affects the Achilles tendon. Achilles tendinosis symptoms do not involve inflammation; while it can be painful, there is rarely redness or warmth surrounding the soft tissue. That said, when examined with a microscope, tissue with tendinosis will have small tears, known as microtears. This will often cause a thickening of the tendon.
Achilles and calf tightness can contribute to the condition, which is more often seen in older people. The muscle and connective tissue experiences microtears through everyday activities that cause the tendon to flex and retract, like walking and climbing stairs. Bone spurs on the heel can also rub against the tendon, abrading the tissue over time and causing tendinosis.
Because the condition does not create inflammation, treating Achilles tendinosis symptoms with ice and anti-inflammatory medications, will not do much. If you suspect your Achilles pain is tendinosis, see a doctor to get a proper diagnosis and treatment.
While Achilles tendinitis and tendinosis are the best-known forms of Achilles tendinopathy, other conditions may affect the tendon and cause pain in a similar way. Below is a list of common conditions that may fit your Achilles pain symptoms.
Haglund’s Deformity/Haglund’s Syndrome
This is a bony enlargement on the back of the heel. When the bone rubs against shoes, the soft tissue near the Achilles tendon can become irritated, often leading to painful inflammation. This pain and irritation is called Haglund’s Syndrome, which is the term for the inflammation of regional soft tissues and the thickening of the Achilles tendon associated with the enlargement.
Peritendinitis/Paratendinitis
Achilles peritendinitis is an activity-induced condition that causes a thickened paratenon, of the tissue that fills the space between a tendon and its sheath. Achilles paratendinitis is the inflammation of the covering of the Achilles tendon. This inflammation can cause scarring that restricts the motion of the tendon. Like most Achilles tendinopathy conditions, it is caused by overuse, repeated movements, and poorly fitted shoes.
Retrocalcaneal/Retro-Achilles Bursitis
This is the most common heel bursitis, or inflammation of the fluid-filled sac at the heel. Often found in athletes, it is characterized by pain and swelling over the back of the heel and pain when using calf muscles. Treatment generally includes ice and anti-inflammatory drugs, such as ibuprofen.
Insertional Tendinopathy vs. Mid-Substance Tendinopathy
These are different types of tendinopathy. Insertional tendinopathy occurs at the calcaneus-Achilles tendon junction, or where the Achilles tendon meets the heel bone. Mid-substance tendinopathy explains when the pain occurs mid-tendon.
Depending on the severity of the condition, a doctor will prescribe a range of treatment for Achilles tendinopathy and related disorders/Achilles pain. Several possible treatment plans are described in detail below.
Physical Therapy
Physical therapy can promote Achilles tendinopathy recovery by addressing pain, swelling, strength, flexibility, and body control. Range-of-motion treatment can slowly build up strength in the tendon, leading to its repair and a decreased chance of future injury. Physical therapy is often prescribed in addition to other treatment.
Prolotherapy
This is an injection therapy in which a natural irritant, such as dextrose, is injected into the soft tissue of an injured joint. The treatment is meant to stimulate healing. Doctors use prolotherapy to treat injured joints and ligaments, most commonly in the back, knees, and Achilles tendon. This is a non-surgical treatment and is also known by the terms “regenerative joint injection” and “non-surgical ligament and tendon reconstruction.” The overall effectiveness of prolotherapy is questioned, however, though members of the medical community believe it to be a safe alternative to surgery.
Sclerotherapy
Though used frequently to treat varicose and spider veins, sclerotherapy can be used to treat Achilles tendon pain. The treatment involves an injection of a salt solution directly into an affected vein, irritating the lining of the blood vessel and causing it to collapse. Sclerotherapy, using ultrasound guidance, is often placed in the ventral paratenon portion of the Achilles tendon. However, more investigation is needed to determine the long-term effects of this type of treatment.
In most cases, Achilles tendinopathy is treated with initial rest, activity modification, and walking boot mobilization when necessary.
In contrast to tendinopathy and tendonitis, a ruptured Achilles tendon is a partial or complete tear. Athletes appear to be the most susceptible to this type of injury, but it can happen to anyone. When the Achilles tendon ruptures, you may hear a popping sound behind the heel. This is often followed by an immediate, sharp pain at the back of the ankle that extends up the lower leg. Most people will experience any of the following when the Achilles tendon ruptures.
A popping sound similar to a ruptured Achilles is also common with a torn calf muscle, which may also feel like being kicked in the calf. A sprained ankle may also make a popping sound, while the pain tends to stay more localized to the foot. If you suspect an Achilles tendon rupture (or torn calf muscle), seek a doctor immediately, especially if you cannot walk properly. Surgery is often required to repair the rupture, but nonsurgical treatment can also work.
Surgery is not required for Achilles tendinitis. Instead, a doctor will suggest an over-the-counter medication or prescribe something stronger to relieve the Achilles pain. Physical therapy is a popular treatment, as specific, targeted stretching and strengthening can promote the tendon’s healing. Orthotic devices can also elevate the heel and relieve strain on the tendon.
Achilles tendinosis may sometimes require surgery to correct. If the chronic condition has damaged the tendon significantly, a surgeon may remove the “bad” portion of the tendon and repair accordingly. However, many patients can improve without surgery. This treatment often involves intense physical therapy, massage, orthotics, and/or a walking boot or brace.
An Achilles rupture will frequently require surgery, but it depends on your age, activity level, and the severity of the tear. Nonsurgical treatment typically involves resting, crutches, ice, over-the-counter pain medication, and/or a walking boot. However, if the tendon is completely severed, you will need surgery. The procedure often involves making an incision in the back of the lower leg and stitching the torn tendon back together. Achilles tendon surgery is minimally invasive but will require extensive rehabilitation, such as physical therapy.
Achilles tendon surgery recovery can range from several weeks to multiple months. In the days immediately following the surgery, a patient will feel very tired, and the lower leg and ankle will remain swollen. There will be significant numbness around the incision site, and the ankle and shin may be bruised. Ice can reduce the swelling, which should disappear in several days.
A walking cast or boot is often required for the first 6 to 12 weeks following surgery. After a few weeks, you may be able to put weight on the affected leg, but it will take several months before regaining the complete use of the leg and ankle. Most people will return to their former level of activity with four to six months, but this timeline can change depending on a patient’s commitment to rehabilitation.
Following the prescribed rehabilitation program is essential for a safe and timely tendon heal. However, remember that each person will recover at a different pace and that these suggested recovery times may not fit every patient’s situation.