Achilles Tendinitis (Tendonitis): Causes, Symptoms, and Treatments

What is Achilles tendinitis?

Achilles tendinitis, also known as Achilles tendonitis, 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.

Achilles tendon enables plantar flexion and stabilisation of the ankle joint. It specifically assists in the everyday movement of our feet during walking, running, jumping and climbing stairs. But in case of an injury or certain systemic diseases in the body, the tendon might get inflamed which then results in Achilles tendinitis.

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

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

• Affects the middle portion of the Achilles tendon.

• More common in younger, more active individuals.

• Non-insertional Achilles tendinitis occurs when the fibres in the middle part of our 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

• Affects the lower portion of the tendon.

• More common in the general population. Can occur in both active and less active individuals.

  • 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.

• Symptoms include pain at the back of the heel, swelling near the heel and possible bone spur formation

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

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, excessive use of the tendon followed by inadequate rest, can lead to injury and inflammation, causing 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)

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 tendon

• Leg fatigue and weakness

• Excessive discomfort especially after an active day 

• Relief in symptoms after rest or in the morning

Possible complications of Achilles tendinitis

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

Achilles tendinosis

• Achilles tendinosis is different from Achilles tendinitis/tendonitis.

• Unlike tendinitis, tendinosis does not involve active inflammation.

• Achilles tendinosis involves the chronic degeneration of the Achilles tendon due to repeated stress (overuse) or untreated tendinitis. 

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 to diagnose Achilles tendinitis?

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)

• Computed tomography (CT) scan

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 orthotics 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, running re-education to regain your strength

  • Shockwave therapy, which uses soundwave 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 conservative management for more than 6 months, your doctor may suggest surgical treatment. You may be referred to a foot and ankle surgeon for the 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.

• 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. Your big toe would still be able to move, walk and run but you wouldn’t be allowed to play sports competitively after this procedure.  

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 help to reduce 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 orthotics shoes that fit your feet.

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

• Avoid frequent running uphill or uneven ground.

Understanding the causes, symptoms and treatments available for Achilles tendinitis affecting you is an important first step in addressing your condition. Early recognition of symptoms can be beneficial for appropriate management. Request for 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 pain and stiffness along the Achilles tendon, especially in the morning, and swelling or thickening in the affected area.

Is walking good 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. Wearing improper footwear or skipping warm-ups should also be avoided.

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.

Disclaimer: 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 for an appointment with our specialists at Thomson Medical for an accurate diagnosis and personalised treatment plan.