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Achilles tendinitis
Definition
Achilles tendinitis is inflammation, irritation, and swelling of the Achilles tendon (the tendon that connects the muscles of the calf to the heel).
Alternative Names
Tendinitis of the heel
Causes
There are two large muscles in the calf, the gastrocnemius, and soleus. These muscles generate the power for pushing off with the foot or going up on the toes. The large Achilles tendon connects these muscles to the heel.
These are important muscles for walking. This tendon can become inflamed, most commonly as a result of overuse or arthritis, although inflammation can also be associated with trauma and infection.
Tendinitis due to overuse is most common in younger individuals and can occur in walkers, runners, or other athletes, especially in sports like basketball that involve jumping. Jumping places a large amount of stress on the Achilles tendon.
Tendinitis from arthritis is more common in the middle aged and elderly population. Arthritis often causes extra bony growths around joints, and if this occurs around the heel where the Achilles tendon attaches to the heel bone, the tendon can become inflamed and painful.
Symptoms
Symptoms usually include pain in the heel when walking or running. The tendon is usually painful to touch and the skin over the tendon may be swollen and warm.
Achilles tendinitis may make you more likely to have an Achilles rupture. This condition usually causes a sharp pain, like someone hit you in the back of the heel with a stick.
Exams and Tests
On physical exam, a doctor will look for tenderness along the tendon and for pain in the area of the tendon when the patient stands on their toes.
Imaging studies can also be helpful. X-rays can help diagnose arthritis and an MRI will demonstrate inflammation in the tendon.
Treatment
Treatment for Achilles tendonitis is usually non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen, rest, ice, and physical therapy. In addition, you should limit any activities that make the symptoms worse.
Occasionally, a cast, brace, or boot may be used to keep the heel still and allow the swelling to go down.
If these treatments fail to improve symptoms, surgery may be needed to remove inflamed tissue and abnormal areas of the tendon.
Outlook (Prognosis)
Conservative therapy is usually successful in improving symptoms, although they may recur if the offending activity is not limited or if the strength and flexibility of the tendon is not maintained.
When necessary, surgery has been shown to be very effective in improving pain symptoms. However, if pain does not improve with treatment and vigorous activity is continued, the tendon is at risk of completely tearing.
Possible Complications
The worst complication is tearing of the tendon. This occurs because the inflamed tendon is abnormal and weak and continued activity can cause it to rupture. In this case surgical repair is necessary, but made more difficult because the tendon is not normal.
When to Contact a Medical Professional
If you have pain in the heel around the Achilles tendon that is worse with activity, contact your health care provider for evaluation and possible treatment for tendinitis.
Prevention
Prevention is very important in this disease. Maintaining strength and flexibility in the muscles of the calf will help reduce the risk of tendinitis. Overusing a weak or tight Achilles tendon is a set-up for tendinitis.
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