Achilles Tendinitis: Causes, Symptoms, and Treatments

What is Achilles tendinitis?

Achilles tendinitis is an inflammation of the Achilles tendon, which is the thickest and the strongest tendon in your body. It is located at the back of your lower leg and connects the heel bone to the calf muscle.

The Achilles tendon enables your ankle to move up or down and helps stabilise it when we walk or run. However, an injury or a repetitive movement can inflame the tendon, leading to Achilles tendinitis.

Learn more about the different types of tendinitis (tendonitis) here.

What causes Achilles tendinitis?

Achilles tendinitis is caused by repetitive movements of the Achilles tendon, which places excessive stress on it. This condition is a common sports injury among runners and athletes. 

When you run, your calf muscles help to push back your feet and raise them as you go forward. However, overuse of the tendon and insufficient rest can result in injury and inflammation, leading to Achilles tendinitis.

Common risk factors for Achilles Tendinitis

• Sports that involve quick starts and stops

• Running

• Dancing

• Jobs that put stresses on ankles and feet (such as laborers)

Types of Achilles tendinitis

The Achilles tendon can develop inflammation and degeneration in two distinct areas, leading to different types of tendinitis. Understanding these 2 main types helps explain why you might experience different symptoms based on where the pain occurs.

Non-insertional Achilles tendinitis

A non-insertional Achilles tendinitis occurs when the fibres in the middle part of the Achilles tendon break down and develop tiny tears. This can lead to tendon swelling and thickening, resulting in pain and stiffness, particularly during and after activities.

Insertional Achilles tendinitis

This condition affects the lower portion of the tendon and is more common in the general population. This condition usually occurs in people who overuse the tendon, such as those who have to walk long distances daily.

The area where the tendon connects to the heel may become inflamed, and extra bone growth (bone spurs) might develop.

For personalised advice about managing Achilles tendinitis, you may consult with a specialist from Thomson Medical. Request an appointment with our specialists today.

Achilles tendinitis symptoms

If you are experiencing inflammation in your Achilles tendon, you will most likely present with the following symptoms: 

• Heel pain (insertional) or ankle pain (non-insertional)

• Stiffness and tenderness within the tendon

• Swelling at or around the injured ankle

• Leg fatigue and weakness

• Excessive discomfort, especially after an active day 

• Relief in symptoms after rest 

Possible complications of Achilles tendinitis

The complications that you may encounter from long-term Achilles tendinitis are:

Achilles tendinosis

The long-term breakdown of the Achilles tendon due to overuse or untreated tendinitis is known as Achilles tendinosis. Unlike tendinitis, tendinosis does not involve active inflammation.

Achilles tendon rupture

An Achilles tendon rupture occurs when the Achilles tendon that connects your calf muscles to your heel bone experiences a partial tear or is fully torn. 

When the Achilles tendon ruptures, you may experience pain, swelling, and weakness in the injured foot, making it difficult to walk normally.

Learn more about Achilles tendon rupture.

How is Achilles tendinitis diagnosed?

Your doctor can usually diagnose Achilles tendinitis based on a physical examination alone. To further confirm the diagnosis, imaging may be done for further evaluation of your Achilles tendon. It also helps in determining the severity of the inflammation.

Imaging examination may include:

• X-ray

• Ultrasound

• Magnetic resonance imaging (MRI)

Achilles tendinitis treatment

Non-surgical treatments

Treatment for Achilles tendinitis depends on its severity.Your doctor may first suggest non-surgical treatment to reduce the inflammation of your Achilles tendon. It may take weeks to months to recover, especially if you have had the symptoms for a few months.

• RICE method

  • Rest: Limit physical activities that place excessive stress on your Achilles tendon. Switch to low-impact physical activities such as swimming.

  • Ice: Put ice on the inflamed area for around 20 minutes, throughout the day.

  • Compression: Compress the region with surgical tape or athletic wrap to stabilise your Achilles tendon during recovery. This also helps to improve blood flow to help with recovery.

  • Elevation: Elevate your leg on the pillow above your heart level to reduce swelling.

• Other non-surgical treatments

  • Wearing supportive shoes, heel lifts and orthotic footwear

  • Using a splint at night to help your tendon stay stretched during sleep

  • Exercises at home, such as calf-stretch

  • Physical therapy such as strengthening exercises, massaging, and running re-education to regain your strength

  • Shockwave therapy, which uses sound waves to reduce pain and improve healing

  • Pain relief such as non-steroidal anti-inflammatory drugs (NSAIDS)

Surgical treatments

If your Achilles tendinitis does not improve with non-surgical management after 3 to 6 months, your doctor may suggest surgical treatment. Based on the severity, there are a few options for surgical treatment:

• Gastrocnemius recession

  • Your surgeon will lengthen your calf muscles, which allows your heel to shift downwards to a more natural position. This procedure can be performed endoscopically (keyhole).

• Debridement and repair

  • If most of your tendon is healthy, the surgeon removes only the damaged part of your Achilles tendon and stitches together the remaining healthy tendon.

• Debridement and tendon transfer 

  • If most of your tendon is damaged, and there is not much of a healthy part to function. Your surgeon will transfer part of your tendon from your big toe to your heel bone. 

How to prevent Achilles tendinitis?

If you feel slight discomfort around your ankle or heel, it is best to not let this progress to complete inflammation of the tendon. There are a few ways to prevent Achilles tendinitis from occurring: 

• Warm up before you exercise or play sports. 

• Stretching calf muscles helps to reduce the risk of getting Achilles tendinitis.

• Avoid repetitive stress on your Achilles tendon.

• Slowly increase the intensity and strength of your exercise. 

• Avoid fast starts and stops.

• Wear supportive shoes and custom orthotic shoes that fit your feet.

• Keep your muscles constantly active with adequate rest throughout the year.

• Avoid frequent running uphill or on uneven ground.

Early recognition of Achilles tendinitis symptoms can be beneficial for appropriate management. Request an appointment with our orthopaedic specialists for a thorough assessment of your condition today.

FAQ

What is the fastest way to heal Achilles tendonitis?

The fastest way to heal Achilles tendonitis involves rest, ice therapy, and anti-inflammatory medications to reduce swelling. Going for physical therapy exercises can also aid in strengthening the tendon and speeding up recovery.

What are 2 signs of Achilles tendonitis?

Two common signs of Achilles tendonitis are tenderness and stiffness along the Achilles tendon.

Is walking beneficial for Achilles tendonitis?

Walking in moderation may be helpful for Achilles tendonitis if it doesn't cause pain, but overdoing it can worsen the condition. It’s important to focus on low-impact activities and follow medical advice.

Does Achilles tendonitis go away?

Yes, Achilles tendonitis can go away with proper care, including rest, physical therapy, and avoiding activities that strain the tendon. Persistent cases may require medical intervention.

What not to do with Achilles tendonitis?

Avoid activities that put excessive stress on the tendon, like running or jumping, as they can exacerbate the condition. You should also avoid wearing improper footwear or skipping warm-ups.

Should I stretch or massage a sore Achilles?

Gentle stretching and massage can help relieve tension and improve flexibility. But make sure you avoid aggressive techniques that may worsen the pain or inflammation.

Can Achilles tendonitis go away on its own?

Mild cases of Achilles tendonitis may resolve on their own with rest and reduced activity, but ignoring the symptoms can lead to chronic issues or tendon rupture.

The information provided is for general knowledge only and should not be considered a substitute for professional medical advice. If you're experiencing any of these symptoms, request an appointment with our specialists at Thomson Medical for an accurate diagnosis and personalised treatment plan.