Tendons keep your muscles connected to your bones. Tendinitis occurs when these tendons become inflamed. If the inflamed tendon is your Achilles, you have Achilles tendinitis.
“Achilles tendinitis is a common injury that can affect your ability to walk, run, climb and jump,” says Dr. Cory Messerschmidt, a board-certified orthopedic surgeon and sports medicine specialist at Beaufort Memorial Orthopaedic Specialists. “Thankfully, the right care brings relief in most cases, so you can recover fully and return to life.”
Achilles Tendinitis Causes and Definition
The Achilles tendon is a large tendon that runs down the lower part of each leg. These tendons connect your heel bones to your calf muscles and play a large role in your mobility.
Use it too much, and this tendon can become injured and inflamed. When this happens, you have Achilles tendinitis. This inflammation is common if you run a lot, suddenly increase your exercise intensity, play a sport that requires a lot of jumping or wear improper footwear.
Depending on where the inflammation takes place, you may be diagnosed with either of the following:
- Insertional Achilles tendinitis — Inflammation affects the lower area of the tendon, where the tendon connects to the heel bone. This injury is often the result of excessive stress on the Achilles tendon caused by tight calf muscles. With this condition, you may also develop bone spurs on your heels.
- Noninsertional Achilles tendinitis — This inflammation affects the middle of the Achilles tendon. When this happens, the fibers in the tendon may break down and develop small tears. If this happens, the tendon may swell and become thicker.
Both conditions are common among runners, according to the American Academy of Orthopaedic Surgeons. That said, noninsertional tendinitis often affects younger runners, while insertional Achilles tendinitis may occur at any age, regardless of your activity level.
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Symptoms of Achilles Tendinitis
Recognizing an inflamed Achilles tendon is essential for timely diagnosis and treatment.
“The most recognizable symptom is heel pain and swelling,” Dr. Messerschmidt says. “However, Achilles tendinitis can result in other frustrating symptoms that limit your mobility and affect your quality of life.”
Symptoms you may experience with Achilles tendinitis include:
- Extreme pain the day after exercise
- Heel pain that comes on when wearing shoes
- Morning pain or stiffness along the affected tendon
- Swelling that worsens with activity
- Thickened Achilles tendon
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Steps to Diagnose Achilles Tendinitis
If you suspect Achilles tendinitis is slowing you down, your primary care provider will ask about your symptoms. During a physical examination, your healthcare provider will assess you for signs of Achilles tendon inflammation. You may be asked to stretch your calf or point your toes downward. If these movements cause heel pain or uncover limited ankle range of motion, further testing can help pinpoint the cause of your problem.
Imaging tests your healthcare provider may prescribe include:
- Magnetic Resonance Imaging (MRI)
- Ultrasound
- X-ray
Along with confirming a diagnosis, these imaging exams can rule out other conditions. MRI is often used to detect similar conditions, such as Achilles tendon ruptures, and to plan surgery for tendinitis.
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Treating Your Aching Achilles
Overcoming Achilles tendinitis requires proper care. While most cases resolve with conservative treatments, some require more intensive approaches, including surgery. To reduce the risk of your injury getting worse, seek care if you have extreme pain or your pain worsens with activity.
Conservative Treatment Options
Noninvasive treatments that may bring healing and relief for Achilles tendinitis include:
- Ice — Apply ice to the affected area two or three times a day for 15 to 20 minutes at a time.
- Lifestyle changes — Stop any activity that causes pain or swelling and try new exercises. If running causes you pain, consider swimming or biking. This change allows you to stay fit without aggravating your inflamed tendon.
- Over-the-counter medication — Nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin and ibuprofen, help manage pain and inflammation.
- Physical therapy — Strengthening exercises and stretches can protect your Achilles tendon from further harm.
- Updated footwear — Proper shoes can guard against heel pain. You may also benefit from a brace, boot or cast while the swelling in your Achilles tendon goes down. Inserting a heel lift in your shoe can also bring relief.
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When You Need Something More
“As effective as conservative treatment is for Achilles tendinitis, some cases don’t respond to this approach,” Dr. Messerschmidt says. “In these cases, we turn to alternative therapies or surgery. Otherwise, you run the risk of your condition worsening or your tendon rupturing.”
Treatment options your care team may recommend when other approaches don’t bring relief include:
- Extracorporeal shockwave therapy (ESWT) — A machine sends acoustic shockwaves through the affected tendon. These shockwaves aid in healing and provide pain relief.
- Platelet-rich plasma injections — Platelets removed from your blood are injected into the injured tendon. These platelets then work to bring healing to the hurting area.
- Surgery — The orthopedic surgeon may remove or repair damaged tissue in the Achilles tendon. If bone spurs have formed, they are also removed. Once finished, the surgeon reattaches the repaired tendon to the heel bone. In some cases, the surgeon may lengthen the calf muscle to reduce stress on the Achilles tendon.
“It can take up to a year to recover from surgery, but it usually helps patients regain full function,” Dr. Messerschmidt says. “Seeing patients walk on their own and return to their favorite activities safely is very gratifying.”
Fast Facts: Achilles Tendinitis
As painful as it is, Achilles tendinitis is a treatable condition that can be managed with proper care.
- Achilles tendinitis occurs when the long tendon down the back of your leg gets inflamed. It can cause pain, swelling and other uncomfortable symptoms.
- Diagnosing an inflamed Achilles tendon begins with a thorough medical examination. If appropriate, your team may order imaging studies, such as X-ray or MRI.
- Conservative treatment often brings long-term relief from Achilles tendinitis, but not always. When other approaches don’t work, surgery can bring healing and restored function.
Request an appointment with one of our orthopedic sports medicine specialists.
