Achilles Tendinitis - Types, Causes, Symptoms, Risk Factors, Diagnosis and Treatment

What Do You Mean By Achilles Tendon?

Tendons are strong fibrous structures in our body that help connect a muscle with a bone. The Achilles tendon is a tendon that connects our heel bones with the calf muscles at the back of our legs. It is otherwise known as the calcaneus tendon. The Achilles tendon is regarded to be the strongest and largest tendon of the human body. This tendon helps you point your toes towards the ground and tiptoe. It aids in walking, jumping, climbing stairs, and running.

What Is Achilles Tendinitis?

Whenever the Achilles tendon gets inflamed after an irritation, the condition is referred to as Achilles tendinitis. Inflammation is the bodily response to any injury or infection that results in pain and swelling more commonly. This condition is also known as Achilles tendonitis. Though this tendon is strong enough to withstand the forces from daily movements, it can get inflamed due to overuse and degeneration. Pain and swelling at the junction of the heel and lower end of the calf muscle are the most common presenting symptoms of this condition.

This condition does not result overnight. The long-term repetitive irritation to the Achilles tendon eventually causes pain and swelling. In instances, certain people do not even know that they have Achilles tendinitis because of the absence of any symptom. In that case, the condition asymptomatically progresses to Achilles tendinosis, wherein the tendon fibers break down, scars form, and permanently thicken.

What Are the Types of Achilles Tendinitis?

Achilles Tendinitis is of two types,

• Non-Insertional Achilles Tendinitis - The middle portion of the Achilles tendon gets irritated and inflamed. As a result, swelling and thickening of the tendon occur which appears as a bulge above the heel region at the back of the leg. This type affects the younger population frequently. The damaged tendon can calcify over time.

• Insertional Tendinitis - This type of tendinitis occurs at a lower level than the non-insertional Achilles tendinitis corresponding to the back heel region (slightly above it). It is named as such because the region where the Achilles tendon inserts at the heel region is affected. The damaged tendon can calcify. Followed by that, there are chances that the bone spurs too can form in the affected region.

What Causes Achilles Tendinitis?

Overuse or improper use of the heel region due to the following factors causes Achilles tendinitis:

• Abruptly starting an aggressive exercise program.

• Having tight calf muscles.

• Exercising with worn-out shoes.

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• Exercising with wrong gears.

• Suddenly increasing the intensity of your physical activity.

• Failing to warm up the calf muscles before an intense workout or sports session.

• Presence of extra bone spur in the back heel region.

• Flat feet.

• Training in cold weather.

• Abruptly twisting, turning, running, and stopping the leg from one position to another.

• Pushing the region to overdo than meant to.

What Symptoms Do People With Achilles Tendinitis Go Through?

• Pain, especially of burning type in the back heel region. The pain can shift and involve the lower calf muscle region and the heel bone.

• Pain worsens with activity.

• Extreme pain in the morning.

• Stiffness along the Achilles tendon region.

• Swelling above the heel region at the back of the leg.

• Tendon thickening.

• Warmth over the skin of the Achilles tendon region.

• A crackling sound while moving the ankle.

Who Is at Risk of Achilles Tendinitis?

• Athletes, especially runners, sprinters, and long marathon runners.

• Tennis and basketball players.

• Skiers.

• People using Fluoroquinolones.

• Dancers.

• People with obesity, high blood pressure, and psoriasis are also at risk.

What Investigations Help Diagnose Achilles Tendinitis?

Based on your symptom, your doctor will do a physical examination of your affected leg to look for symptoms such as pain, swelling, stiffness, etc. Then the following tests might be requested to confirm the diagnosis;

• X-Rays - An X-ray of the affected region reveals the presence of bony spurs and tendon calcification if any.

• MRI (Magnetic Resonance Imaging) - An MRI of the Achilles tendon region might be ordered only if your doctor suspects tendon rupture and plans for surgical management. Otherwise, this imaging test shows how damaged the tendon is.

How Can Achilles Tendonitis Be Treated?

Both non-surgical and surgical treatment options are available to treat the condition.

Non-Surgical Treatment Options:

• Rest - By rest, you only need to eliminate activities that put stress on your heel, such as high-impact exercises (skiing, tennis, jumping, etc.), and switch to low-impact exercises such as swimming.

• Ice - Place ice packs over the swollen Achilles tendon region multiple times a day for at least 15 minutes.

• Medications - Painkillers such as NSAIDs (nonsteroidal anti-inflammatory drugs) can be used for pain relief. Drugs like Naproxen and Ibuprofen belong to NSAIDs. However, the long-term intake needs a doctor's advice.

• Exercises - Once your pain subsides, you can practice wall stretching, balancing on your toe exercises, and toe raises to strengthen your calf muscles. This can lessen the stress on the Achilles tendon.

• Eccentric Strength Training (Bilateral Heel Drop) - In this exercise, you need to stand on a stair with only your front half of the feet on the stair, and the back half of the heel must be hanging freely. Now hold the railings to attain balance, raise your toe, and slowly lower it to the lowest possible position. Repeat this 20 times. Once you become comfortable and master the procedure, continue with a single leg at a time.

• Orthotics - Heel lifts, shoes with a soft heel, silicone Achilles sleeve, and walking boots help relieve the strain and irritation of the tendon.

Surgical Treatment Options:

Initially, all non-surgical management methods are followed, and if the condition does not improve even after six months of conservative treatment, then surgical options are considered. Based on the extent of inflammation and region affected, one of the following surgeries are recommended:

• Gastrocnemius Recession - This procedure is employed to lengthen the calf muscle because short calf muscles can be tight, resulting in tendinitis.

• Debridement and Repair - In conditions where there is less than 50 % of the tendon damage, the damaged portion of the tendon is cut and removed. The remaining part of the tendon is sutured back. At times metal anchors might be placed to hold the Achilles tendon in position with the heel bone. Bone spurs, if any present, will also be removed.

• Tendon Transfer - Conditions involving more than 50 % of the tendon damage require the removal of an extensive part of the damaged tendon. In such cases, to support the remaining tendon, another tendon that supports the big toe is moved to the heel bone.

After surgery, you might need to use removable casts or boots while walking for a week or two based on your physician’s recommendation. Post-healing rehabilitation with physical therapy will be required for at least a year. You will be able to resume your normal physical activities, but if your damage and surgery are extensive, then you might not be able to perform vigorous physical activities that strain the heel region.

Conclusion

Practice using appropriate and well-fitting comfortable footwear for walking, running, or sports activities. Warming up before any sports activity and having a proper gait can prevent Achilles tendinitis to a greater extent. If you happen to notice pain or swelling in your lower back calf muscle area or heel region, do not ignore it. Get it checked by your physician and treat it in the earlier stages before the condition worsens.