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What is Achilles Tendinitis?

Inflammation of the Achilles tendon is known as Achilles tendinitis or tendonitis.

The Achilles tendon is a tough band of fibrous tissue that runs down the back of your lower leg and connects your calf muscle to your heel bone. The tendon is used when you walk, climb, jump, run and stand on your tip toes.

Causes of Achilles Tendinitis

Achilles tendinitis occurs as a result of repetitive stress to the tendon. The stress may be due to:

  • Overuse of the tendon
  • Degeneration of the tendon
  • Intense physical activity
  • A sudden increase in activity
  • Tight calf muscles
  • Bone spurs or extra bone growth
  • Rheumatoid arthritis and/or infection

Types of Achilles Tendinitis

Based on which part of the tendon is affected, Achilles tendinitis can be differentiated into:

  • Insertional Achilles tendinitis: In this type, the lower portion of the tendon, where it attaches (inserts) to the heel bone is inflamed due to bone spurs.
  • Non-insertional Achilles tendinitis: In this type, the middle portion of the tendon breaks down with tiny tears (degenerate), swells, and thickens. This is more commonly seen in younger and active people.

Signs and Symptoms of Achilles Tendinitis

Some of the signs and symptoms of Achilles tendinitis include:

  • Stiffness and pain along the Achilles tendon.
  • Swelling and thickening of the tendon.
  • Swelling or discomfort in the back of your heel.
  • Pain in the back of your heel that worsens with activity.
  • Tight and stiff calf muscle.
  • The skin on the heel is warm to touch.
  • Limited motion when you flex the foot.

What if Achilles Tendinitis is Left Untreated?

If Achilles tendinitis is left untreated, it may cause:

  • Severe pain
  • Trouble walking or exercising
  • Deformation of the tendon or heel bone
  • Total tear or rupture of the Achilles tendon

Diagnosis of Achilles Tendinitis

To begin with, your doctor will physically examine your calf, heel, foot and ankle to look for symptoms associated with Achilles tendinitis and ask you some questions on how you got injured. Your doctor will also palpate the affected area to elucidate the exact location of pain or discomfort.

Subsequently, imaging tests may be ordered to confirm the diagnosis of Achilles tendinitis. These tests include:

  • X-rays: For images of leg bones and foot (to check for bone calcification)
  • MRI scans: To detect tendon ruptures or tissue degeneration
  • Ultrasounds: To check for tendon damage or inflammation

Treatment of Achilles Tendinitis

Treatment for Achilles tendonitis ranges from home remedies to nonoperative therapies to surgery.

As a home remedy, you may be advised to use RICE protocol: Rest, Ice, Compression (with bandage) and Elevation, which is usually effective in treating Achilles tendinitis.

Afterward, you may be given non-steroidal anti-inflammatory drugs (NSAIDs) or steroid or PRP injections as a nonoperative therapy. You may also be told to wear a brace and undergo physical therapy involving certain exercises.

If the pain does not improve after 6 months of nonsurgical treatment, surgery may be considered to repair your Achilles tendon. The specific type of surgery depends on the amount of damage to the tendon and the location of the tendinitis.

In an “open repair” type surgery, your surgeon:

  • Makes a surgical cut above the heel bone to open your leg.
  • Stitches the 2 sides of the ruptured tendon back together.
  • Closes the incision to complete the surgery.

In another type of surgery, your surgeon:

  • Makes a surgical cut to open the ruptured area of the leg.
  • Passes needles with sutures through the tendon and the skin.
  • Then ties the sutures together to complete the surgery.

Other surgical methods include:

  • Debridement and repair: If the tendon has less than 50% damage, the damaged part is removed, and the remaining healthy part is repaired with sutures or stitches.
  • Debridement with tendon transfer: In cases where the tendon has more than 50% damage and the remaining portion is not strong enough to function alone, an Achilles tendon transfer is performed.
  • Gastrocnemius recession: This is the surgical lengthening of the calf muscles. The procedure is performed for people who have difficulty in flexing the foot, despite consistent stretching.

Though rare, complications such as infection, slow wound healing, damage to nerves and soft tissues, and bleeding may occur after any of the above surgeries. It may take you anywhere from a few weeks to a few months to recover fully.

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