Definition Achilles tendinitis is an inflammation of the Achilles tendon, sometimes called the heel cord, which connects the calf muscles to the heel bone.
What is going on in the body? Achilles tendinitis is usually the result of an injury or tiny tears in the tendon fibres. Two types exist:
insertional, where the tendon attaches to the heel bone
non-insertional, which occurs slightly higher up the tendon
What are the signs and symptoms of the disease? Achilles tendinitis is associated with local pain, usually slow in onset, and a limp, causing difficulty running and jumping. Exercise can make the symptoms either better or worse. The discomfort varies from being just a nuisance to being very painful and restrictive.
The back of the shoe may cause painful pressure on the attachment of the tendon to the heel bone. Sensitivity at the site of inflammation is a consistent sign. For non-insertional tendinitis, swelling is frequently seen and felt. Sometimes there is a rubbing feeling with gliding of the tendon as the ankle moves back and forth. The person may have trouble walking on his or her toes, because of pain in the tendon.
What are the causes and risks of the disease? Multiple factors may cause Achilles tendinitis. The most common is overuse. Frequently, a sudden increase in training, running, mileage, or speed will bring on symptoms. Pressure from the hard back of an athletic shoe can irritate the tendon over the heel. Landing hard on the arch of the foot may contribute to the strain on the Achilles 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 is important before and after running or exercise. Using orthotics, or arch supports, in footwear can be preventive. Making sure that the back of the shoe is soft enough is another preventive strategy.
How is the disease diagnosed? Diagnosis is based on the symptoms and signs discussed above. X-rays do not often reveal abnormalities, but sometimes hardening of the tendon can be observed or an abnormal piece of bone or bone spur is seen where the tendon connects to the back of the heel. X-rays may also show an unusual bump of the heel, which can rub and irritate the tendon.
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 in activity, stretching, ice after activity, or NSAIDs (non-steroidal anti-inflammatory drugs). Physiotherapy focusing on stretching and strengthening, massage, alternating hot and cold baths, and ultrasound or sound waves can be beneficial. The temporary use of a heel lift or the insertion of an arch support or orthotic into the shoe can also help. Although seldom necessary, the ankle may be kept in a short leg cast or splint. Surgery is rarely necessary, but can remove bone spurs or the bony prominence of the heel bone. The injection of corticosteroids, such as cortisone, into the area of the Achilles tendon should be avoided due to the possibility of causing tendon rupture.
What are the side effects of the treatments? NSAIDs may cause indigestion, ulcers, or gastrointestinal bleeding. They may also affect the kidneys or liver. Surgery has a risk of infection, tendon injury, or problems with skin healing in an area of poor blood supply.
What happens after treatment for the disease? Without sufficient protection, rupture of the tendon may occur. After full recovery, a person is generally able to go back to regular activities.
How is the disease monitored? Pain and swelling should be monitored. Feeling a sudden "pop" usually means the tendon has ruptured, which requires a cast or surgery to avoid permanent disability.
Author: John A.K. Davies, MD Reviewer: eknowhow Medical Review Panel Editor: Dr John Hearne Last Updated: 21/10/2004 Contributors Potential conflict of interest information for reviewers available on request
