Achilles Tendinitis

Click here for printer friendly PDF file.

The achilles tendon is the largest tendon in the body. It is huge compared with other tendons and it can be easily felt on the back of the ankle above the heel.

The achilles tendon is also extremely strong and has been tested to withstand tremendous forces. The calf muscles, gastrocnemius and soleus, are connected to the heel bone or calcaneus by the span of the achilles tendon.

It is paradoxical that this largest and strongest tendon is also the one that is most frequently ruptured.

Inflammation of the tendon

No one knows for certain exactly why achilles tendons become inflamed, but there are several theories which include trauma caused by a hard contraction of the calf muscles, increase in running speed or mileage in runners, and starting up too quickly after a lay off.

Signs

Some people are fortunate in that their achilles tendon will begin to complain and they will experience mild pain after exercise or running. This discomfort can gradually worsen.

The pain can be more severe and sometimes diffuse.

Stiffness and tenderness in the morning in the tendon, one or two inches above its attachment to the heel is frequent. Some swelling in the region of the tendon can occur.

However, in my practice experience, the tendon usually will rupture practically without warning. The tendon ruptures in males many times more often than females. The typical person that this happens to is in his thirties or forties and might be playing recreational basketball.

The person feels an intense, sudden pain in the achilles tendon area that is often described as feeling as if they were shot in the area.

Treatment

The typical torn or ruptured achilles tendon is repaired surgically as soon as it is practical to do so. While it is not an emergency it should be repaired in the first several days after the injury if at all possible for best results.

For those fortunate few who experience symptoms before the tendon actually ruptures, rest for a week can be very helpful.

Sometimes we prescribe anti-inflammatory medication such as Motrin or any of the other popular medications.

A simple heel pad or heel lift in the shoe from 1/4 to 1/2 inch can reduce stress on the achilles tendon significantly and make the person more comfortable.

Physical therapists often employ stretching and appropriate exercises for the calf muscles as well as the muscles in the front of the leg. Whirlpool and ultrasound also can be helpful sometimes combined with a type of cortisone cream, which the ultrasound can propel into the tissues (iontophoresis).

Prevention

It is hard to get people to do things to prevent injury in my experience. If they are not having any symptoms in a particular area it is fairly difficult to get people to do things to try to prevent something from happening.

If you are a runner you should probably get the best running shoes you can afford. Some people require professionally made orthotics to provide proper foot and heel alignment.

Walking and stretching to warm up are always suggested, but seldom done.

These are all very good suggestions, but unfortunately hardly anyone will do them.

Calf stretching exercises done on a regular basis, even though you may not feel that you need to do this, can't be beat. Avoid hill running and unaccustomed sprinting. Increase your running distance or sports activities very gradually.

Anyone who experiences achilles tendon rupture or even achilles tendinitis, develops an appreciation of the Greek god, Achilles, who was vulnerable only at his heel.