Achilles Tendinitis

The Achilles tendon is both the largest and strongest tendon in the human body, this fibrous tissue runs from your calf to your heel bone. You use your Achilles tendon every time you move, to push off and take a step. Not surprisingly, it can become easily irritated, inflamed or even ruptured. There are 2 types of Achilles tendinitis injuries, non-insertional tendinitis which affects fibers in the middle of the tendon and insertional tendinitis which affects the lower portion of the tendon where it attaches to the heel bone.

Achilles tendinitis occurs when the tendon becomes inflamed due to excessive pronation, is overused or suffers from tissue degeneration. The Achilles is subject to limited blood supply and a variety of forces which make it susceptible to injury. By increasing the load on your Achilles tendon from activities like running and jumping you make it even more vulnerable to injury. Extreme forces across the tendon complex will cause prolonged loading of the tendon and result in microtrauma and inflammation. Although the Achilles tendon is designed to withstand significant stress factors from activities like running and jumping it will become irritated if the normal, smooth gliding motion of the tendon is impaired.

Additional factors that may lead individuals to contract and contribute to tendinitis is bowlegs, high arches, flat feet, obesity, excessive tightness, poor gait, cold temperatures, inadequate shoe support during activity, high heels, aging and an increase in activity; particularly velocity and vertical sports.

As we age, the Achilles becomes less flexible, tissue degeneration and degradation take hold and the tendon is cannot manage the same stress and force loads. Small tears can start to develop which will further weaken the tendon and stop it from healing. Increasing blood flow through stretching techniques and graduated intensity will help warm the tendon and surrounding muscle tissue which discourages sudden tears and ruptures. Staying hydrated is also very important for connective tissue like the Achilles tendon. Your tendon should be wet and squishy, not dry and crunchy.

Although the Achilles tendon can withstand forces of 1,000 pounds or more tendinitis is a very common condition and is considered acute for most, effecting approximately 250,000 Americans annually. Achilles tendinitis ranks 3rd behind ankle sprains and plantar fasciitis respectively as the primary presenting injury amongst the athletic community. 18% of runners are effected by Achilles tendinitis and 56% of competitive athletes discontinued all sporting activities for a minimum of 4 weeks to encourage healing. The injury is common amongst tennis players, cyclists, dancers and gymnasts. Tendinitis in athletes is usually caused by training or technique errors or improper footwear. Running produces forces 8 times the body’s weight placing tremendous repetitive stress on the tendon for long periods of time.

Injury to your tendon can be gradual or sudden and the course of healing may be lengthy. The acute inflammation will subside over time with proper treatment. Repeated occurrences, however, can lead to a chronic and more sever condition called tendonosis. Seek medical attention if your pain is severe and persists for more than 7 days following rest and conservative treatment methods. 

If gradual, Achilles tendinitis pain will begin as a mild ache or slight discomfort in the back of the leg, just below your calf, near the ankle joint. The affected leg may also feel noticeably sluggish relative to your other leg. Should your injury go untreated, over time the pain will get worse and may become constant. Swelling and redness of the skin may also develop and your Achilles may become tender to the touch. You may experience stiffness, episodes of diffuse and or localized pain, bone spurs and even a thickening of the tendon itself.

If you are a runner or athlete this pain will likely occur just above the heel after activities; like running, exercise and training or participating in sports. If you experience sudden pain in your heel, calf or Achilles and it becomes bruised and swollen you may have a partial or complete tear of the tendon. This will require immediate medical attention. Prolonged activities like running, HIIT training and sprinting, stair climbing, box jumping and various crossfit movements can exacerbate your condition. You will also experience stiffness and tenderness after sleeping or after long periods of rest due to inactivity and lack of circulation. This will improve with mild activity and blood flow. Swimming is an excellent form of alternative activity that does not stress the tendon. 

Cortisone or corticosteroid injections are strongly discouraged for Achilles tendon injuries as they may further weaken already degenerated, degraded or comprised tissue. Treatment for Achilles injuries will consist of rest, cold therapy or ice and NSAIDs.

A reduction in your daily training and activity regimen is also essential to recovery. If you are a runner, changing your shoes every 300 to 500 miles is recommended. Avoiding dramatic and sudden changes to your exercise regimen; duration, frequency, intensity and location is also advised. Do not increase the frequency, intensity or duration of your exercise regimen more than 10% a week. Acute injuries to the Achilles may take up to 8 weeks to resolve, at which point you may return to your regular training, exercise or running schedule.

If you are allergic to NSAIDs or are concerned about prolonged daily use and potential damage to your kidneys and liver topical analgesics containing herbal and all natural compounds are a good alternative therapy. Electrostimulation, physical therapy and non-invasive medical appliances can also help increase recovery time. Keeping the tendon fixed in place during daily movement will increase resolution dramatically. 

Should conservative treatments fail and your symptoms persist for several months more aggressive modalities may be required to resolve your pain, methods include; ultrasound therapy, radial shockwave therapy and even surgical intervention. Postoperative care consists of 6 to 10 weeks of immobilization with subsequent transition to full weightbearing complemented by aggressive rehabilitation. It may take between 6 to 12 months to return to normal activities depending on the individuals age, health and rehabilitation therapy.