Achilles tendon is the name of the largest tendon in the body and it is the one that connects the heel bone with that of calf muscles. It is found in the back of your leg closer to the heel. Achilles tendon is the bone that is used for walking, jumping and running. It is subjected to wear and tear over age and sometime it degenerates due to increased stress and old age. Achilles tendinitis is the condition in which the Achilles tendon becomes inflamed due to over usage and degeneration. Any part of the body develops swelling and pain if it is used in excess or subjected to severe stress.
Types :
Achilles tendinitis can be categorized into two types based on the area of the tendon that is affected.
- Non-insertional tendinitis is one in which the middle fiber portion of the tendon degenerates and develops swelling.
- Insertional tendinitis is one in which the lower part of the heel develops inflammation giving rise to extra bone growth. This type of tendinitis can occur to anyone even if they are not active.
Causes :
The basic cause of Achilles tendinitis is repeated stress on the tendon. This can happen accidentally or sometimes when we exert ourselves to do some task. Extra growth of the bone can cause Achilles tendinitis. The point at which the tendon gets attached to the heel develops bone spur giving rise to tendinitis.
Accident, trauma or injury to the heel bone, misalignment of the bone can cause Achilles tendinitis. Achilles tendinitis can develop if a person exerts too much and gets involved in intense exercise suddenly. Any type of exercise should be increased gradually so that the body gets adjusted to the process. If you have tight calf muscles it can put extra strain on the tendon leading to Achilles tendinitis.
Symptoms :
Some of the common symptoms are stiffness and hardening of the bone in the mornings, pain on the back of the heel portion which increases when you run or jump and severe pain after completing exercise like walking or jogging. The tendon portion of the heel develops swelling due to bone spur (excess of bone growth) and as you use the heel bone for walking or doing any exercises the pain will continue to increase. Some people may experience a sudden “pop” feeling on the calf muscle which indicates the tendon has broken or torn.
Diagnosis :
Your doctor will look for the above symptoms and will examine the foot for swelling and stiffness. He will check if there is any thickening of Achilles tendon or any extra bone growth at the lower portion of the tendon. He may order for imaging tests like X-rays to check if there is any swelling and/or CT and MRI scan to get a clear picture of the tendon.
Treatment :
For mild to moderate pain due to Achilles tendinitis, you can take painkillers of prescription strength to get relief from symptoms. Remember it will take some time (3 months or even more) for the bone to heal due to inflammation even if you take medications. You will be asked to take complete rest and stop any exercise regimen since it would add more stress to your tendon.
Variety of treatment options is available for Achilles tendinitis and your doctor will decide the appropriate method after considering your age, health and nature of tendinitis. You can also apply ice pack on the swelling to reduce inflammation and to get relief from pain quickly. For severe pain, your doctor would prescribe NSAID medications like naproxen or ibuprofen for some days. But you should not take these drugs for more than one month since it can cause side effects.
- Exercise Therapy :
Your therapist will teach you easy exercises for building strength on your calf muscles. Stretching of calf muscles can help you to overcome pain and rigidity and it would improve blood circulation also. Initially you can learn from physiotherapist to do stretching and tightening exercises and later you can practice the same at your home. Eccentric strengthening exercise is good in reliving the stress of bone spur.
For more severe cases cortisone injection is directly given on the tendon to reduce inflammation but your doctor will take precautions to ensure that the tendon does not rupture inside. Wearing supportive shoes can reduce swelling and pain on the affected tendon. It would also reduce the extra strain from the tendon thus you can walk easily with comfort. Heel lifts are recommended for people with insertional tendinitis to reduce the strain from the tendon. For some people, ESWT (shockwave therapy) is given for healing the inflammation of tendon.
- Surgery :
Surgical approach is considered only if the damage is severe or if the tendinitis is located inside. For some types of tendinitis non-invasive treatments is not possible. Your surgeon will slightly increase the length of calf muscle using gastrocnemius recession. This would give relief from extra strain on the calf muscles. Open incision is made with general anesthesia or small incision is made to complete the surgery with endoscopy. During this procedure, the damaged tissues of the tendon are removed and the healthy portion is retained.
For some people the surgeon will insert a metal anchor to keep the Achilles tendon in proper place. In case the tendon has been damaged more than 50% for the patient, then the doctor would consider options like tendon transfer surgery. Bothe the types of surgery have good chances of recovery but the time of recovery can be long if the damage to the tendon is more. The patient may not be able to participate in sports activities after surgery and it is necessary to do exercises as per the instructions of your doctor for speedy recovery.
Prevention :
You can prevent Achilles tendinitis by doing regular strengthening and stretching exercises and wearing right size of shoes. If you feel any pain on the heel bone for some days it is good to consult your doctor since the injury can get worse if not treated in time.
