Achilles tendinitis

Suffering from pain in the back of your ankle? Then there is a good chance you have Achilles tendinitis. Don’t despair, regular exercise may help you significantly reduce the severity of your pain. What’s more, a routine of tailored exercises may drop your odds of developing future symptoms.

Get active now: strengthen, mobilize and regain control. Killing the pain without the pills.

Finn Johannsen Specialist MD in rheumatology



Do you suffer from pain in the back of your ankle? It’s possible you have Achilles Tendinitis (or Tendonitis). This is a common sports-related injury that can occur in both recreational as well as competitive athletes. It can also affect people who are not active.1 If you have symptoms of Achilles Tendinitis, don’t despair. Regular exercise can help to significantly reduce the severity of your pain. What’s more, a routine exercise program can reduce your odds of developing similar symptoms in the future.

At Injurymap, we understand how frustrating pain from Achilles Tendinitis can be. We are here to help you better understand the condition with this informative guide. Our mission is to help you get active, strengthen, mobilize, and regain control – killing the pain without the pills. Remember, if your symptoms are severe or persistent, you should always seek care from a healthcare provider.

Content:

What is Achilles Tendinitis?

Causes of Achilles Tendinitis

Insertional Achilles Tendinitis

Non-insertional Achilles Tendinitis

Achilles Tendinitis Symptoms

Complications

Achilles Tendinitis Diagnosis

Treatment

Recovery Time

What is Achilles Tendinitis?

Achilles Tendinitis refers to an inflammation or irritation of the Achilles tendon, which is the strongest and thickest tendon in the human body. Three large muscles in the calf combine to form a tough band of fibrous tissue called the Achilles tendon. The tendon connects the muscles of the calf to the heel bone.2 You use the Achilles tendon to run, walk, jump, climb stairs, and lift your heel. The tendon is palpable behind the ankle as the heel cord.

Achilles pain

The Achilles tendon can endure a great deal of stress and tension. However, it is prone to inflammation and irritation (tendinitis) due to excessive use and degenerative changes. The inflammation is usually mild to moderate, but in rare cases, it can be severe and lead to tendon rupture. Like all the other tendons in the body, the Achilles tendon stiffens as a person grows older. This puts older individuals at an increased risk of injury.

It’s important not to mistake Achilles tendinitis for another similar condition called retrocalcaneal bursitis, which is an inflammation of a bursa located near the heel bone. If your symptoms do not improve with home treatment, please see a doctor to rule out other foot problems, such as heel bursitis, arthritis, plantar fasciitis, and stress fracture.

Causes of Achilles Tendinitis

Despite the considerable strength of the Achilles tendon, many people suffer injuries to it. In most cases, inflammation of the Achilles tendon is due to overuse or abnormal use, i.e., repetitive or intense strain on the tendon. Injuries can occur due to an increased load on the tendon, e.g., increasing the walking or running distance or jumping on hard surfaces. Wearing improperly fitting shoes and abnormal footing (for example, a predisposition to flatfoot or hollow foot) also increases the risk of inflaming the Achilles tendon.

Achilles tendon and the leg muscles

As noted, the term tendinitis refers to inflammation of a tendon. It is the body’s natural response to disease or injury, resulting in symptoms such as pain, swelling, and irritation.2Achilles tendinitis is not usually caused by a specific injury. Rather, it occurs as a result of the tendon undergoing repetitive stress. This commonly happens if you suddenly increase repetitive activity that stresses the Achilles tendon, leading to tiny tears in the tendon fibers. The body is unable to repair the ongoing damage to the tendon, resulting in symptoms such as swelling and pain.3

Athletes are at risk of suffering from inflammation of the Achilles tendon. In particular, “weekend warriors” (people who play sports or perform athletic activities only on the weekends) can develop Achilles tendinitis due to lack of proper conditioning.3 Individuals who suddenly increase physical activity (for instance, a sudden increase in running mileage without allowing the body to adjust) are at risk of injuring the Achilles tendon.2

Other risk factors for Achilles Tendinitis are running uphill or running on uneven surfaces.6 Sports that involve quick starts and stops or changes in direction, such as tennis and basketball, are also possible causes. Achilles tendinitis is an occupational hazard for laborers whose work puts their ankles and feet under stress.3 Other factors that can increase the risk of developing Achilles tendinitis include tight calf muscles combined with an intensive exercise regimen. A bone spur (growth) near the heel bone can irritate the tendon by rubbing against it, leading to tendinitis.2

Insertional Achilles Tendinitis

This is an inflammation of the bottom part of the tendon in the area where it inserts (attaches) on the heel bone. It commonly occurs in association with a bone spur (outgrowth) near the calcaneus (heel bone). Insertional Achilles Tendinitis can occur even in individuals who are not active. However, it is typically seen after years of wear and tear, for example, in long-distance runners.2

Non-insertional Achilles Tendinitis

This involves the middle fibers of the tendon. Degenerative changes (microscopic tears) in these fibers lead to a thickening and swelling of the tendon. This type of Achilles Tendinitis is more common among active young people.

Achilles Tendinitis Symptoms

When the Achilles tendon is overloaded, it will feel sore and often swell due to the inflammation. The pain usually begins as a mild ache in the heel after sports activities. It’s important you listen to these symptoms. If you ignore the pain and continue stressing the tendon or overloading it with activity, the tendon is at risk of rupture. A ruptured Achilles tendon may require surgery.

The most common Achilles Tendinitis symptoms

  • Pain and stiffness behind the heel, particularly in the morning, which improves with mild activity.
  • Pain in the heel that is worse with activity and/or severe pain after exercise.
  • Tenderness and warmth of the skin of the heel.
  • Reduced range of movement in flexing the foot (bending it upwards toward the front of the leg).
  • Tendon thickening and swelling that gets worse throughout the day with activity.2,4

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Complications

A rehabilitation exercise program and home treatments can often help Achilles tendinitis. However, if conservative treatment doesn’t work, it’s important to see a doctor. If the tendinitis gets worse, it can lead to complications, such as pain, difficulty walking, warping of the tendon, and a partial or complete rupture of the Achilles tendon, which may require surgery to fix.4,7 If you hear a “pop” that seems to come from the back of the heel, this could be a tendon rupture, and you should get immediate medical care.4

Achilles Tendinitis Diagnosis

A doctor can diagnose Achilles Tendinitis based on your symptoms, medical history, and physical examination. You may be asked to stand on your heels to test flexibility and range of movement. The doctor may palpate (feel) your heel to pinpoint the area of maximum pain and swelling.4 Imaging tests, such as X-rays, MRI, and ultrasound, can help confirm a diagnosis of Achilles Tendinitis by demonstrating degeneration and inflammation; however, these tests are typically not necessary to make a diagnosis.4

Treatment

In the majority of people, nonsurgical treatments provide relief from pain. Here’s an overview of the various treatments for Achilles Tendinitis.

Rest: It’s important to cut back or even cease activities that worsen the pain from Achilles Tendinitis. You should avoid jumping, running, and other similar activities that burden the tendon. Stay physically active, though. It is a good idea to switch from high-impact activities like running to something like swimming, cycling, or walking short distances.4 This will assist in the treatment of your Achilles tendon and reduce pain in the heel and calf muscles. Choose soft, shock-absorbing shoes – preferably with a small heel lift – to relieve the Achilles tendon during everyday activities in the recovery period.

Ice: Placing an ice pack on the area can help reduce pain. This can be repeated as often as required throughout the day for 20 minutes at a time. You should stop the icing when the skin feels numb.4

Exercise: If you suffer from inflammation of the Achilles tendon, it’s important to keep using your ankle to maintain flexibility and work on its stability. Strengthening the calf muscles will reduce stress on the tendon. You may experience some pain in the Achilles tendon, both during and after exercising. The pain should never be severe and should level off quickly to what you were experiencing before the activity. Your pain should not increase from day to day either. It’s important to perform exercises correctly to ensure maximum benefit. The Injurymap app has exercises developed by experts that allow you to gain strength and flexibility in the comfort of your home.

Stretching: Gentle stretching of your leg muscles and the Achilles tendon should be a core part of your treatment for the inflammation. You can perform stretches while standing on flat ground or a staircase, as outlined below. Always perform stretching exercises slowly and hold each stretch for 30 – 45 seconds.

Strength training: This is a crucial part of your exercise routine. It builds up the Achilles tendon’s ability to withstand the daily load of activities without risking further damage. It typically takes three to six months to build up sufficient strength in the tendon before you can resume heavy sporting activities safely.

Exercises for Achilles tendinitis

  1. Heel lift with bent knees I
    5 reps

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    • Stand with your feet slightly apart.
    • Your toes should point straight ahead.
    • Slowly move your knee past the toes so that your ankle and knee bends.
    • Move the knees forward as far as possible, so that the ankle is bent to a maximum.
    • You should feel it tightening in the back and front of the ankle, but it should not hurt.
    • Keep your knees bent while slowly raising your heels, so that you're standing on your toes.
    • Hold your balance for a few seconds then slowly lower your heels again.
    • Perform 5 repetitions.
  2. Ankle bend on the floor
    15 reps x 3 sets

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    • Sit on the floor with your legs stretched.
    • Tie an exercise band to a solid object.
    • Place the exercise band over the toes so that it tightens and flex your ankle using the exercise band as resistance.
    • Go back and forth.
    • Perform 3 sets of 15 repetitions with each leg.
  3. Achilles tendon stretch
    30 sec. x 3 sets

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    • Stand with bare feet.
    • Place your toes up against a wall.
    • Bend the knee a little and move it towards the wall.
    • You should feel it stretching at the bottom of the back of the heel and in the arch of the foot.
    • Hold the stretch for 30 seconds and perform 3 repetitions with each leg.

Pain medication: Non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen and ibuprofen can help with symptoms of Achilles Tendinitis, such as pain and swelling. Many of these pain medications are available over-the-counter without a prescription for short-term use. However, if you have used OTC painkillers for more than a month, you should consult a healthcare provider as they can be harmful in the long run.4

Steroid injections: Corticosteroids are powerful anti-inflammatory agents that can assist effectively in getting rid of the inflammation. Particular care should be given to rehabilitation of the Achilles tendon after injection treatment, as the absence of pain, provided by the injection, might prompt a too early resumption of vigorous activity. This might in turn lead to a recurrence or worsening of the condition.

Orthotics and splints: Heel lifts can relieve pressure on the tendon and reduce irritation from shoes. They are especially useful in people with Insertional Achilles Tendinitis.1 Custom orthotic devices may help people with Achilles tendinitis due to overpronation (flat feet). Night splints may be prescribed to stretch the Achilles tendon during sleep.3

Surgery: Surgical treatment of Achilles tendinitis is typically recommended if there is no improvement in pain after 6 to 12 months of conservative treatment. The procedure may involve lengthening the calf muscles or removing a damaged portion of the Achilles tendon.

Recovery Time

Achilles tendinitis usually gets better with a few weeks of home treatment consisting of rest, ice, and exercises. Usual exercise rehab time is 3 – 6 months. Recovery can take longer if you continue to put stress on the tendon.4

What is the fastest way to treat Achilles Tendinitis?

The quickest way to recover from Achilles Tendinitis is rest, ice, and stretching and strengthening exercises. You may take anti-inflammatory painkillers for 7-10 days to manage the symptoms.8

Achilles rupture

How long does it take for Achilles Tendinitis to heal?

If it’s caught and treated early, you can recover from Achilles Tendinitis in a couple of weeks. If not, the symptoms can last for up to 6 months.9

What happens if Achilles Tendinitis goes untreated?

Without treatment, Achilles Tendinitis can worsen into a chronic (longstanding) painful condition with an increased risk of tendon rupture, requiring surgery.10

Things you can do to prevent Achilles Tendinitis
  • Warm-up before exercising, playing a sport, or performing repetitive movements.
  • Stretch and strengthen your calf muscles with daily exercises. Stay active year-round.
  • Mix and match workouts. Combine high- and low-impact activities to reduce constant stress on the Achilles tendon.
  • Ease into a new exercise routine. Gradually increase the frequency and intensity of your workouts.
  • Avoid exercising on uneven surfaces.
  • Stop activities that cause pain.
  • Wear proper shoes with cushioning and arch support appropriate for your foot type and activity.3,4,6

Achilles Tendinitis is commonly an overuse injury. If you run or play sports like basketball and tennis, you should be extra vigilant about preventing Achilles injury. Always stretch the lower leg muscles by warming up before any exercise. You can prevent Achilles Tendinitis by strengthening the tendon and calf muscles. The Injurymap app offers a range of stretches and exercises to improve strength and flexibility in your lower leg and ankle. This can help in recovery from Achilles Tendinitis as well as prevention of future episodes.

Injurymap makes rehabilitation exercises accessible to everyone. Take advantage of the 14-day free trial to see what the app is all about. You’ll find it is an incredibly easy way to exercise at your convenience so that you can heal from Achilles Tendinitis and prevent it from returning.

Treat your pain with Injurymap

Download the app to get a customized program that addresses your specific pain with exercises.

About the author

Finn Johannsen is a specialist MD of rheumatology with a diploma in sports and musculoskeletal medicine, as well as an award-winning specialist in rehabilitative treatment of sports and work-related injuries.

References:


  1. https://www.uptodate.com/contents/achilles-tendinopathy-and-tendon-rupture 

  2. https://orthoinfo.aaos.org/en/diseases--conditions/achilles-tendinitis/ 

  3. https://www.foothealthfacts.org/conditions/achilles-tendon-disorders 

  4. https://www.healthline.com/health/achilles-tendinitis#symptoms 

  5. https://www.ncbi.nlm.nih.gov/pubmed/11515194 

  6. https://my.clevelandclinic.org/health/diseases/15225-achilles-tendon-injury---including-achilles-tendinitis-and-achilles-tendon-rupture 

  7. https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=134&ContentID=215 

  8. https://www.webmd.com/fitness-exercise/guide/achilles-tendon-injury#1 

  9. https://intermountainhealthcare.org/blogs/topics/sports-medicine/2013/10/the-secret-to-treating-achilles-tendonitis/ 

  10. http://www.iskinstitute.com/kc/ankle/achilles_tendinitis/achilles_tendinitis.html 

  11. https://www.mayoclinic.org/diseases-conditions/achilles-tendinitis/symptoms-causes/syc-20369020