Achilles Tendinitis: Symptoms, Causes & Treatment Options

What Is Achilles Tendinitis?

Achilles tendinitis is an inflammation of the Achilles tendon, usually resulting from repetitive strain or overuse. This condition is particularly common among runners, athletes, and middle-aged individuals who engage in sports or physical activities. The Achilles tendon, being the largest and strongest tendon in the body, is crucial for walking, running, and jumping. When this tendon becomes inflamed, it can cause pain, swelling, and stiffness in the back of the ankle, making it difficult to carry out daily activities or exercise.

Types of Achilles Tendinitis

There are two main types of Achilles tendinitis:

• Noninsertional Achilles Tendinitis: This type involves the middle portion of the tendon, a few centimetres above where it attaches to the heel bone. It is more common in younger, active individuals. Overuse and repetitive strain can cause tiny tears in the tendon fibres, leading to inflammation and pain.
• Insertional Achilles Tendinitis: This type affects the lower portion of the tendon, where it inserts into the heel bone. It is more frequent in older or less active people. In addition to inflammation, insertional tendinitis may also involve the growth of bone spurs at the tendon's attachment point.

How Common Is Achilles Tendinitis?

Achilles tendinitis is one of the most common causes of heel pain, especially among runners and active individuals over the age of 30. It accounts for a significant proportion of cases seen in sports medicine and orthopaedic clinics.

What Are the Symptoms of Achilles Tendinitis?

The most common Achilles tendinitis symptoms include:

• Pain and stiffness along the Achilles tendon, especially in the morning
• Pain that worsens with activity, particularly running or climbing stairs
• Severe pain the day after exercising
• Thickening of the tendon
• Bone spurs (insertional tendinitis)
• Swelling that worsens with activity
• Tight calf muscles

In severe cases, the pain may be present even at rest.

What Are the Causes of Achilles Tendonitis?

The most common Achilles tendinitis causes are:

• Sudden increase in the intensity or amount of exercise
• Tight calf muscles that put extra stress on the Achilles tendon
• Bone spurs in the heel that rub against the tendon
• Exercising without a proper warm-up
• Wearing improper or worn-out shoes during exercise

Who Is at Risk for Achilles Tendinitis?

Several factors can increase your risk of developing Achilles tendinitis:

• Age: The condition is more common in middle-aged adults.
• Sex: Men are more likely to be affected than women.
• Sports: Runners and athletes who participate in sports involving jumping or quick directional changes are at higher risk.
• Obesity and chronic conditions: Being overweight or having conditions like diabetes or high blood pressure can increase your risk.
• Certain medications: Fluoroquinolone antibiotics have been linked to a higher incidence of Achilles tendon problems.
• Occupations requiring prolonged standing: Jobs that involve standing for long periods can put extra strain on the Achilles tendon.
• Footwear and calf tightness: Wearing unsupportive shoes and having tight calf muscles can also contribute to the development of Achilles tendinitis.

What Are the Complications of Achilles Tendinitis?

If Achilles tendinitis is not treated promptly, it can lead to:

• Chronic (long-term) pain and swelling in the ankle and heel
• Tendon tears or rupture—a painful injury that usually requires surgical repair
• Bursitis—painful swelling of the fluid-filled cushions (bursae) around the tendons
• Permanent heel bone growth (bone spurs)

How Is Achilles Tendinitis Diagnosed?

During Achilles tendinitis diagnosis, your doctor will ask about your symptoms and examine your ankle and foot. They will gently press on the tendon to check for swelling tenderness and assess the range of motion and flexibility of your ankle.

What Tests Will Be Done to Diagnose Achilles Tendinitis?

In some cases, imaging tests may be ordered to get a clearer picture of the extent of the damage:

• X-rays can reveal any bone spurs on the heel (common with insertional tendinitis).
• Ultrasound can show tendon thickness, swelling, and any tendon tears.
• MRI can reveal more details about the condition of the tendon and surrounding tissue.

What Is the Best Way to Get Rid of Achilles Tendonitis?

The primary goal of Achilles tendinitis treatment is to reduce pain and inflammation, promote healing, and prevent recurrence. Here are a few options:

• Rest and activity modification: Avoid activities that aggravate your Achilles tendinitis symptoms and give your tendon time to heal. You may need to temporarily switch to low-impact exercises like swimming or cycling.
• Ice and anti-inflammatory medications: Applying ice to the affected area for 15-20 minutes several times a day can help reduce swelling and pain. Over-the-counter NSAIDs may help short-term, though prolonged use is not always recommended.
• Physical therapy: A physical therapist can guide you through a series of stretching and strengthening exercises for your calf muscles and Achilles tendon. Eccentric exercises, which involve lengthening the muscle under tension, have been shown to be particularly effective in treating Achilles tendinitis.
• Proper footwear and orthotics: Wearing supportive shoes with adequate cushioning and arch support can help reduce strain on the tendon. Custom orthotics or heel lifts may also be recommended to correct any biomechanical issues contributing to your condition.
• Immobilisation: In severe cases, your doctor may advise using a walking boot or brace to immobilise the ankle and allow the tendon to rest and heal.
• Shockwave therapy: For chronic cases that don't respond to conservative treatments, extracorporeal shockwave therapy (ESWT) may be considered for chronic cases not responding to conservative care, though evidence of benefit is mixed.

When Does Achilles Tendinitis Need Surgery?

In some cases, surgery may be necessary to treat Achilles tendinitis. Your doctor may recommend surgical intervention if:

• Your symptoms persist or worsen despite 6-12 months of conservative treatment
• You have a large tear or rupture in the tendon
• There is significant tendon degeneration or damage
• You have developed bone spurs that need to be removed (in insertional tendinitis)

Surgical procedures for Achilles tendinitis can include:

• Debridement: Removing damaged or degenerative tendon tissue to promote healing
• Tendon repair: Stitching together torn tendon fibres
• Gastrocnemius recession: Lengthening the calf muscle to reduce strain on the tendon
• Bone spur removal: Excising any bone spurs that have formed at the tendon's insertion point.

What Are the Complications of Achilles Tendinitis Surgery?

As with any surgical procedure, there are potential risks and complications associated with Achilles tendinitis surgery, including:

• Infection
• Nerve damage
• Blood clots
• Delayed wound healing
• Re-rupture of the tendon
• Stiffness or weakness in the ankle

How to Prevent Achilles Tendinitis?

Preventing Achilles tendinitis involves taking steps to reduce strain on the tendon and minimise your risk factors:

• Gradually increase the intensity and duration of your workouts
• Always warm up properly before engaging in physical activity
• Stretch your calf muscles regularly to maintain flexibility
• Wear supportive shoes that fit well and provide adequate cushioning
• Replace worn-out shoes in a timely manner
• Maintain a healthy weight to reduce stress on your tendons and joints
• Address any underlying medical conditions that may increase your risk

By incorporating these preventive measures into your daily routine, you can significantly reduce your chances of developing Achilles tendinitis.

What Is the Outlook for People With Achilles Tendinitis?

The prognosis for individuals with Achilles tendinitis is generally good, especially when the condition is recognised and treated early. Most people can recover fully with conservative treatments like rest, ice, physical therapy, and proper footwear. However, the healing process may take several weeks to a few months, depending on the severity of the injury.

In cases where the tendon is severely damaged or torn, or when conservative treatments fail to provide relief, surgery may be necessary. While surgical intervention can lead to a longer recovery period, most people are able to return to their previous level of activity with proper rehabilitation.

How Can We Take Care of Ourselves if We Have Achilles Tendinitis?

If you've been diagnosed with Achilles tendinitis, there are several steps you can take to manage your symptoms and promote healing:

• Follow the RICE protocol—rest, ice, compression, and elevation.
• Perform stretching and strengthening Achilles tendonitis exercises as directed by your doctor or physical therapist.
• Avoid activities that put excessive strain on your Achilles tendon.
• Wear shoes that provide good support and cushioning for your feet.
• Consider orthotics if you have any foot alignment issues.
• Gradually return to your sport or activity once pain and swelling subside.
• See your doctor if your pain worsens or interferes with your daily activities.

When to See a Doctor About Achilles Tendon Pain

It's important to consult a doctor if you experience:

• Severe pain or swelling in the Achilles tendon area
• Difficulty walking or bearing weight on the affected leg
• A popping or snapping sensation in the ankle or calf
• Persistent pain that doesn't improve with rest and self-care measures.

Conclusion

Achilles tendinitis is a common and often preventable condition that can significantly impact your quality of life if left untreated. By understanding the Achilles tendinitis causes, symptoms, and risk factors associated with this injury, you can take proactive steps and maintain your mobility. Most cases can be successfully managed with conservative treatments like rest, ice, physical therapy, and proper footwear.

At Metropolis Healthcare, we understand the importance of accurate diagnosis and personalised care in managing conditions like Achilles tendinitis. Our team of experienced pathologists and phlebotomists is dedicated to providing reliable diagnostic services and convenient at-home sample collection to help you take control of your health.

FAQ's

What are the first signs of Achilles tendinitis?

The first signs of Achilles tendinitis are usually pain and stiffness at the back of the ankle, just above the heel. The pain may be mild at first and worsen with activity. The area may also feel tender to the touch and look slightly swollen.

Does Achilles tendinitis go away?

Yes, with proper treatment, Achilles tendinitis usually goes away completely. However, it's important to rest from aggravating activities and follow treatment recommendations as suggested by your doctor.

Can Achilles tendinitis heal without surgery?

Yes, the majority of cases of Achilles tendinitis can heal without surgical intervention. Conservative treatments like rest, ice, anti-inflammatory medications, and physical therapy are often sufficient to manage symptoms and promote healing.

What exercises help recover from Achilles tendinitis?

Exercises that help recover from Achilles tendinitis include gentle stretching of the calf muscles and Achilles tendon, as well as eccentric strengthening exercises that involve lengthening the muscle under tension.

How long does it take for Achilles tendinitis to heal?

With proper treatment, most people recover from Achilles tendinitis within 3-6 months. Mild cases may resolve in a few weeks, while more severe damage may take 6 months or longer.

When is surgery needed for Achilles tendon problems?

Surgery may be necessary for Achilles tendon problems if conservative treatments fail to provide relief after 6-12 months, or if there is a large tear or rupture in the tendon. Severe tendon degeneration or the presence of bone spurs may also warrant surgical intervention.

Are steroid injections safe for Achilles tendinitis?

Steroid injections are generally not recommended for treating Achilles tendinitis, as they may weaken the tendon and increase the risk of rupture. Instead, other injection options like platelet-rich plasma (PRP) are sometimes being studied, though evidence remains limited.