About Achilles Tendonitis

Achilles tendonitis is an overuse injury that causes inflammation and degeneration of the Achilles tendon, the large tendon that connects the calf muscles to the heel bone. It is one of the most common overuse injuries, especially in runners and athletes.

There are two main types of Achilles tendonitis:

Non-insertional Achilles Tendonitis: Affects the middle portion of the tendon above where it attaches to the heel bone. More common in younger, active individuals.

Insertional Achilles Tendonitis: Involves the lower portion of the tendon where it inserts into the heel bone. Can occur at any age and activity level.

Common Symptoms

• Pain, aching, stiffness in the Achilles tendon area, worse with activity
• Swelling and thickening of the tendon
• Tenderness or severe pain when squeezing the tendon
• Limited ankle range of motion, especially pointing toes down

Cause & Anatomy

• Repetitive stress or overuse of the Achilles tendon, often from increasing activity levels too quickly
• Tight calf muscles, which put extra strain on the tendon
• Bone spurs or deformities that rub against the tendon
• Certain medical conditions like psoriasis or high blood pressure
• Use of certain antibiotics like fluoroquinolones

Diagnosis

Physical Examination

• The doctor will gently press on the affected area to determine the location of pain, tenderness or swelling.
• They will evaluate the flexibility, alignment, range of motion and reflexes of the foot and ankle.

Imaging Tests

• X-rays may be ordered to rule out other conditions like bone problems, though they cannot visualize soft tissues like tendons.
• Ultrasound can visualize the Achilles tendon and detect tears or inflammation. It can also show real-time tendon motion.
• MRI provides very detailed images of the Achilles tendon and can detect partial tears or other damage.

Prevention

By gradually increasing activity, using proper footwear, stretching/strengthening, and varying high-impact activities, many cases of Achilles tendonitis may be prevented.

Increase Activity Gradually

• If beginning a new exercise regimen, start slowly and gradually increase the duration and intensity.
• Avoid sudden increases in repetitive activities that stress the Achilles tendon.

Proper Footwear

• Wear shoes with adequate heel cushioning and arch support to reduce tension on the tendon.
• Replace worn-out shoes regularly.
• Consider arch supports if shoes lack proper arch support.

Stretching and Strengthening

• Stretch the calf muscles and Achilles tendon daily, before and after exercise.
• Strengthen the calf muscles through specific exercises to better handle activity stress.

Cross-Training

• Alternate high-impact activities like running with low-impact like cycling or swimming.

Other Tips

• Warm up properly before exercise.
• Avoid uphill running or excessive hill work that stresses the tendon.
• Stop any exercise that causes Achilles tendon pain and rest.

Treatment

Achilles tendonitis is an overuse injury causing inflammation and degeneration of the Achilles tendon. Proper rest, stretching, and gradually increasing activity levels are key for treatment and prevention. Below are a list of treatments:

• Initial treatment involves rest, ice, compression, and elevating the foot
• Over-the-counter anti-inflammatory medication
• Physical therapy stretches and exercises
• For severe or chronic cases, procedures like ultrasound therapy, injections, or surgery may be needed

Surgery

• Surgery is typically recommended for acute, complete Achilles tendon ruptures to reattach the torn tendon ends.
• Common surgical techniques include open repair, minimally invasive repair, or percutaneous repair.
• The type of surgical approach depends on factors like the location and pattern of the tear, surgeon preference, and patient characteristics.

Rehabilitation

The rehabilitation protocol after Achilles tendon surgery has evolved from highly restrictive to more accelerated functional protocols. The goals are to protect the repaired tendon initially while gradually introducing mobility and weightbearing to optimize functional recovery. The main components are:

Immobilization vs. Early Mobilization

• Traditional protocols involved immobilizing the ankle in a cast or splint for 6-8 weeks.
• Accelerated protocols now allow controlled ankle mobilization exercises within the first few weeks.

Non-Weightbearing vs. Early Weightbearing

• Historically, patients were non-weightbearing for 6-8 weeks post-op.
• Current protocols transition to partial weightbearing as early as 2-4 weeks in a protective boot.

Rehabilitation Phases

• Phase 1 (0-2 weeks): Immobilization, non-weightbearing, elevation to control swelling
• Phase 2 (2-4 weeks): Initiate weightbearing, active dorsiflexion up to neutral
• Phase 3 (4-8 weeks): Advance weightbearing, remove boot wedges, start plantarflexion
• Phase 4 (8+ weeks): Normalize gait, single-leg balance, strengthening

FAQ’s

How is it treated?
Initial treatment involves rest, ice, compression, and elevating the foot. Over-the-counter anti-inflammatories, physical therapy stretches/exercises, and orthotic devices may also be used. For severe or chronic cases, procedures like ultrasound therapy, injections, or surgery may be needed.

Can it be prevented?
Prevention involves gradually increasing activity levels, proper warm-up/cool-down, wearing supportive shoes, doing calf stretches and strengthening exercises, varying high-impact activities, and stopping any exercise that causes pain.

What are potential complications?
If left untreated, Achilles tendonitis can weaken the tendon over time, making it more prone to a complete tear or rupture that usually requires surgical repair.