Achilles tendinitis doesn’t just affect runners and athletes
By Dr. Cory A. Messerschmidt
Beaufort Memorial Orthopaedic Specialists
Tendons connect muscles to bones, and tendinitis occurs when a tendon becomes inflamed. When this affects the Achilles tendon, it’s known as Achilles tendinitis — a common injury that can make walking, running, jumping, and climbing painful.
The Achilles is a large tendon connecting the calf muscles to the heel, playing a crucial role in mobility. It commonly becomes inflamed due to overuse, sudden increases in activity, high-impact sports, or improper footwear, but with the right care, full recovery is achievable.
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, but noninsertional tendinitis often affects younger runners, while insertional Achilles tendinitis may occur at any age, regardless of your activity level.
Recognizing an inflamed Achilles tendon is essential for timely diagnosis and treatment. The most recognizable symptom is heel pain and swelling.
Other 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; and/or
- Thickened Achilles tendon.
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 MRI, ultrasound or an 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.
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.
Treatment options your care team may recommend when conservative 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.
As painful as it is, Achilles tendinitis is a treatable condition that can be managed with proper care.
Fellowship-trained in sports medicine, Cory A. Messerschmidt, M.D., FAAOS, is a board-certified orthopedic surgeon with Beaufort Memorial Orthopaedic Specialists who sees patients at the practice in Port Royal and Okatie.