Achilles Tendinitis

Achilles tendinitis is an inflammation of the Achilles tendon,sometimes called the heel cord, which connects the calf muscles to theheel bone.

What is going on in the body?

Achilles tendinitis is usually the result of an injury or tinytears in the tendon fibers. Two types exist:

What are the causes and risks of the disease?

Multiple factors may cause Achilles tendinitis. The mostcommon is overuse of the tendon. Often, a sudden increase in training, running,mileage, or speed will bring on symptoms. Pressure from the hard backof an athletic shoe can irritate the tendon over the heel. Landing hard onthe arch of the foot may contribute to the strain on the Achilles tendon.

What are the signs and symptoms of the disease?

Achilles tendinitis is associated with heel or ankle pain, usuallyslow in onset, and a limp, causing trouble running and jumping.Exercise can make the symptoms either better or worse. The discomfortvaries from being just a nuisance to being very painful and restrictive.

The back of the shoe may cause painful pressure on theattachment of the tendon to the heel bone. Sensitivity at the site ofinflammation is a consistent sign. For noninsertional tendinitis, swellingis frequently seen and felt. Sometimes there is a rubbing feeling withgliding of the tendon as the ankle moves back and forth. The personmay have trouble walking on his or her toes because of pain in the tendon.

How is the disease diagnosed?

Diagnosis is based on the symptoms and signs listedabove. It’s hard to see this condition in an X-ray, but sometimes hardeningof the tendon can be observed or an abnormal piece of bone or bone spuris seen where the tendon connects to the back of the heel. X-rays mayalso show an unusual bump of the heel, which can rub and irritate the tendon.

What can be done to prevent the disease?

Proper training and footwear are the best prevention.Stretching the calf muscles attached to the Achilles tendon isimportant before and after running or exercise. Using orthotics,or arch supports, in footwear can also help. Making sure that theback of the shoe is soft enough is another strategy.

What are the long-term effects of the disease?

Achilles tendinitis is usually not a permanent problem,although it may take a long time to heal. With repeated or severe stress,the Achilles tendon may rupture.

What are the risks to others?

There are no risks to others.

What are the treatments for the disease?

Achilles tendinitis will often respond to rest or changes inactivity, stretching, ice after activity. NSAIDs, which are nonsteroidal anti-inflammatory drugs, such as ibuprofenor naproxenmay also help. Physical therapy focusing on stretching and strengthening,massage, alternating hot and cold baths, and ultrasound or sound wavescan also help with healing and comfort. The temporary use of a heel liftor the insertion of an arch support, called an orthotic, into the shoe orsneaker can also help. Although seldom necessary, the ankle may bekept in a short leg cast or splint. Surgery is rarely neededbut can remove bone spurs or the bony prominence of the heel bone. Theinjection of corticosteroids such as cortisoneinto the area of the Achilles tendon is usually avoided due to the risk that it willcause tendon rupture.

What are the side effects of the treatments?

NSAIDs may cause indigestion, ulcers, or gastrointestinalbleeding. They may also affect the kidneys or liver. Surgery has a risk ofinfection, tendon injury, or problems with skin healing in an area of poorblood supply.

What happens after treatment for the disease?

Without protection, rupture of the tendon canoccur. After full recovery, a person is generally able to go back toregular activities.

How is the disease monitored?

Pain and swelling should be monitored for any worsening.Feeling a sudden “pop” usually means the tendon has ruptured,which requires a cast or surgery to avoid permanent disability.