Achilles Tendinitis: Everything You Need to Know

The Achilles tendon is the largest in the body, and it can withstand a lot of stress. You use it when walking, jumping, running, climbing stairs, or standing on your tip toes. Achilles tendinitis is acute inflammation that can occur in the tendon itself or where it attaches to the heel. If it occurs in the middle portion of the tendon, the fibers may develop tiny tears and start to break down, which leads to thickening and swelling. If it occurs where the tendon connects to the heel, it is called insertional tendinitis. This type is frequently caused by tight calf muscles and is most common in runners.

Achilles tendinitis is generally not related to a specific injury. It results from repetitive stress that happens when we push ourselves to do too much too quickly, like increasing the duration or intensity of exercise without allowing your body to recover properly. Tight calf muscles put extra stress on the Achilles tendon, which can lead to irritation. Research shows that there may also be a link between obesity and tendonapathy, including Achilles tendonitis.

Symptoms of Achilles tendinitis include pain near the heel or down the back of the leg that typically gets worse with activity or throughout the day. You may also feel it the day after you exercise. The tendon may feel stiff when you first wake up, and it may swell and thicken. Achilles tendinitis can lead to burn spurs forming on the heel bone and difficulty flexing the affected foot.

If you have pain that persists or interferes with your usual routine, seeing a doctor may be a good idea. If you hear a pop or snapping with the sudden onset of severe pain, you may have an Achilles tendon rupture, which requires immediate medical attention. Achilles tendon ruptures are most common in people in their 30s, 40s, and 50s and may result from poor conditioning before exercise, overexertion, diabetes, and genetic factors.

A doctor will examine your foot and ankle, looking for swelling along the back of your heel, bone spurs on the heel, pain in the middle of the tendon, heel pain when stretching the calf muscle, and difficulty pointing your toes downward. Achilles tendinitis may be mistaken for a sprained ankle, so your doctor may order additional tests, including X-rays to assess calcification. An MRI or ultrasound may be needed to plan surgery when other treatments are not effective.

In most cases of Achilles tendinitis, non-surgical treatment options can help bring pain relief and allow for healing. Rest is essential; decreasing or even stopping activity may be necessary. Switch to low-impact exercising like swimming or biking as opposed to running. Your doctor may also recommend an ankle boot or brace to wear during activity. Icing can be helpful throughout the day for up to 20 minutes at a time (or less if the skin becomes numb).

Physical therapy can be very effective at treating Achilles tendinitis. Calf stretches and bilateral and single heel drops are common exercises that can strengthen and stretch the calf muscle and tendon. A physical therapist may also recommend orthotic devices like a wedge or insert that goes into the shoe to raise the heel and eliminate strain on the tendon slightly.

Non-steroidal anti-inflammatories or NSAIDs can help reduce pain and swelling. They can help make the pain manageable during physical therapy and daily activity, but NSAIDs will not directly help the degenerated tendon heal. If you need to use over-the-counter medication for more than a month, talk to your doctor.

Research shows that extracorporeal shockwave therapy (ESWT) can provide pain relief and better outcomes of some Achilles tendon injuries. ESWT uses shockwaves applied to the injured tendon to promote healing. Although more research is needed about how effective ESWT is for treating Achilles tendinitis, it is a low-risk procedure with few complications. Another treatment option is eccentric stretching exercises, which involves tightening the muscle while it is getting longer. These exercises can damage the Achilles tendon more if not done correctly, so they should only be done under the supervision of a trained physical therapist until cleared to do them at home.

Achilles tendon repair surgery may be necessary to fix a damaged Achilles tendon, though this is usually only the case if the tendon ruptures or in instances of severe degeneration. If the tendon is ruptured, the surgeon will remove the damaged section and repair the rest of the tendon with stitches. When the damage is severe, the surgeon may need to replace part or all of it using a tendon harvested from another place in your foot.

If you want to prevent Achilles tendon injuries, warm up before doing any exercising, playing sports, or doing other repetitive movements. Wear the correct type of shoes for your feet and the activity you're doing, and increase activity slowly. Stick to flat surfaces, and stop any activity that causes pain.

Studies show that certain foods and supplements can help support tendon health. Researchers discovered that moderate weekly alcohol consumption was associated with a modestly increased risk of Achilles tendinopathy, though its effects on tendinitis are unknown. Tendons are largely made up of collagen, so collagen supplements may be beneficial, though optimal dosage and duration are unknown. More studies are needed. Some research also shows that leucine, an amino acid, may help stimulate collagen synthesis.

One of the main complications of Achilles tendinitis is a tendon rupture. Signs of a tendon rupture include a sudden onset of pain and an audible "pop" or "snap." Tendon ruptures generally require surgical repair, so if you suspect you have one, see a doctor right away. If you need surgery to repair a tendon rupture, the surgery can have its own complications, most notably, wound infection.

Physical therapy can be an important part of recovery. Attending sessions as ordered by your doctor can be key to healing, but practicing the exercises that the physical therapist teaches you at home is also important. Do not jump right back into your same activity level. Instead, slowly ease your way back into your exercise routine. If you feel any pain, stop.

Achilles tendinitis is an overuse injury commonly caused by overuse or a sudden increase in exercise intensity. Most cases respond to non-surgical treatment options, like rest, ice, wearing a brace or boot, and switching to low-impact exercises. Achilles tendinitis is not without its complications. Tendon rupture can be severe and requires surgical repair. If you feel pain along the back of your calf or heel when exercising, stop, rest, and talk to your doctor to prevent further injury.