Achilles tendonitis

What is the Achilles tendon?

The achilles tendon is the largest tendon in the body. It connects the muscles of your calf to the calcaneus (heel bone) and is used when you walk, run and jump.

Although the Achilles tendon can withstand great stresses from running and jumping, it is vulnerable to injury.

What is Achilles tendinosis ?

In common terms it is inflammation of the tendon which causes pain and swelling at this site. This occurs due to micro tears in the fibres of the achilles tendon and the body constantly trying to repair these tears.

There are two types of tendinosis:

• Noninsertional tendinosis:

In this the fibers in the middle portion of the tendon have begun to break down with tiny tears (degenerate). This makes the tendon swell, and thicken.

Tendinitis of the middle portion of the tendon more commonly affects younger, active people.

• Insertional tendinosis:

This involves the lower portion of the heel, where the tendon attaches (inserts) into the heel bone.

Tendinitis that affects the insertion of the tendon can occur at any age, even in patients who are not active.

What causes Achilles tendinosis?

This problem often occurs due to repetitive stress to the tendon. This happens when we push our bodies too hard or too soon with exercise.

Sudden increase the intensity or amount of exercise activity – for example increasing the amount of distance run daily by a few miles.

Tight calf muscles – can predispose to this problem.

A bone spur at the attachment to the heel bone.

What are the symptoms caused by this condition?

Pain and stiffness along the Achilles tendon in the morning.

Pain along the tendon or back of the heel that worsens with activity.
Severe pain the day after exercising.

Thickening of the tendon.

Swelling.

If you feel a sudden ‘pop’ behind your heel, it may be possible that you have ruptured your achilles tendon. It is important to see a doctor immediately if this happens.

How is this condition diagnosed?

Your consultant will examine your foot clinically.

This usually makes the diagnosis clear. X-Rays and MRI scan will also be done to confirm the diagnosis and plan further treatment.

Can the condition worsen?

People function normally with this problem for years with minimal symptoms. But if the symptoms worsen, it may progress to a complete rupture of the tendon. It is advisable to have yourself assessed by a foot and ankle specialist.

What treatment options are there?

Options are based on the degree of severity of symptoms. Most patients are seeking advice and reassurance. Broadly there are non surgical and surgical options.

Non Surgical Options:

Rest: In acute flare ups, rest in a boot may be necessary for a few weeks. It will also be important to reduce the intensity and exercise levels.

Painkillers: regular anti inflammatories taken for a short duration will help with pain and the swelling.

Exercise and physiotherapy: specific exercises which help to stretch the tendon are used. Physiotherapy is more successful for non insertional compared to insertional tendinosis.

Modification to footwear: Soft heel cups or shoe raise are useful and help improve symptoms.

Shock wave therapy: This can be used if the above methods fail with good results.

Is surgery necessary?

The decision to proceed with surgery should be taken after non surgical options described above have been exhausted. The majority of patients will benefit from shoe wear modifications. If symptoms continue to affect lifestyle and function in spite of this then surgery may be discussed with your consultant and he will advise you regarding the pros and cons of surgery. Surgery involves removing all the degenerate parts of the tendon.