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Achilles tendinitis is when the Achilles tendon becomes swollen, inflamed, and painful at the heel.
The Achilles tendon connects your calf muscles to your heel bone. It is used for walking, running, and jumping.
Causes
There are two large muscles in the calf: the gastrocnemius and the soleus. These muscles create the power needed to push off with the foot or go
up on the toes. The large Achilles tendon connects these muscles to the heel.
These are important muscles for walking. This tendon can become inflamed, most commonly as a result of overuse or arthritis. Inflammation can also occur with injury and infection.
Tendinitis due to overuse is most common in younger people. It can occur in walkers, runners, or other athletes. Sports like basketball that involve jumping put a large amount of stress on the Achilles tendon. Repeated jumping can lead to Achilles tendinitis.
Achilles tendinitis may be more likely to occur:
After a sudden increase in the amount or intensity of an activity
When the calf muscles are very tight (not stretched out)
Tendinitis from arthritis is more common in middle-aged and elderly people. A bone spur or growth may form in the back of the heel bone. This may irritate the Achilles tendon and cause pain and swelling.
Symptoms
Symptoms include pain in the heel and along the tendon when walking or running. The area may feel painful and stiff in the morning.
The tendon may be painful to touch or move. The skin over the tendon may be swollen and warm. You may have trouble standing up on one toe.
Exams and Tests
The doctor will perform a physical exam. The doctor will look for tenderness along the tendon and pain in the area of the tendon when you stand on your toes.
X-rays can help diagnose arthritis.
An MRI scan may be done if your doctor is thinking about surgery or is worried about the tear in the Achilles tendon.
Treatment
The main treatments for Achilles tendinitis do not involve surgery. It is important to remember that it may take at least 2 to 3 months for the pain to go away.
Try putting ice over the Achilles tendon for 15 to 20 minutes, two to three times per day. Remove the ice if the area gets numb.
Changes in activity may help manage the symptoms:
Decrease or stop any activity that causes you pain.
Run or walk on smoother and softer surfaces.
Switch to biking, swimming, or other activities that put less stress on the Achilles tendon.
Your health care provider or physical therapist can show you stretching exercises for the Achilles tendon.
They may also suggest the following changes in your footwear:
A brace or boot to keep the heel and tendon still and allow the swelling to go down
Heel lifts placed in the shoe under the heel
Shoes that are softer in the areas over and under the heel cushion
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen can help with pain or swelling. Talk with your health care provider.
If these treatments do not improve symptoms, you may need surgery to remove inflamed tissue and abnormal areas of the tendon. Surgery also can be used to remove the bone spur that is irritating the tendon.
Extracorporeal shock wave therapy (ESWT) may be an alternative to surgery for people who have not responded to other treatments. This treatment uses low-dose sound waves.
Outlook (Prognosis)
Lifestyle changes usually help improve symptoms. However, symptoms may return if you do not limit activities that cause pain, or if you do not maintain the strength and flexibility of the tendon.
Surgery, if needed, has been shown very effective for improving pain.
Possible Complications
Achilles tendinitis may make you more likely to have an Achilles rupture. This condition usually causes a sharp pain, like someone hit you in the back of the heel with a stick. Surgical repair is necessary, but difficult because the tendon is not normal.
When to Contact a Medical Professional
If you have pain in the heel around the Achilles tendon that is worse with activity, contact your health care provider for evaluation and possible treatment for tendinitis.
Prevention
Prevention is very important in this disease. Maintaining strength and flexibility in the muscles of the calf will help reduce the risk of tendinitis. Overusing a weak or tight Achilles tendon makes you more likely to develop tendinitis.
Alternative Names
Tendinitis of the heel
The following rehabilitation guide is intended for information purposes only. We recommend seeking professional advice before attempting any self help treatment.
Aims of Rehabilitation
---------------------------
1. Decrease initial pain and inflammation.
2. Improve flexibility.
3. Improve the strength of the joint.
4. Re-establish neural control and co-ordination.
5. Return to full fitness.
1.Decreasing Pain and Swelling
This is the first stage of treatment, which can last for anywhere from 3 days to several weeks, depending on the severity of your condition.
Cold therapy - apply for 15 minutes at least three times a day. Every two hours if possible for the first day.
Identify the cause of the injury. Training too much too soon, training on hard surfaces, wearing the wrong shoes or shoes that are too old and not warming up are possible reasons for the injury occurring. Also, if you overpronate, the Achilles is twisted putting more strain on it.
Rest - use crutches if needed.
Place a heel lift of about 1cm into both your shoes to help take the stress off the tendon. Do not leave it there forever! If the calf muscles adaptively shorten, an increased strain will be placed on the achilles tendon in the future.
Anti-inflammatory medication can be taken (under Doctors advice of course).
Maintain fitness by non weight bearing exercise such as cycling if pain allows.
2. Improving Flexibility
Once you can perform daily activities pain-free, move on to this stage.
Concentrate on improving the flexibility of the calf muscles (Gastrocnemius and Soleus). This will reduce the strain on the achilles tendon.
Two stretches in particular are important, one with a straight leg for the Gastrocnemius muscle and one with the leg bent to target the Soleus muscle.
Stretching should be done regularly, three times a day initially and should be maintained long after the injury has healed to prevent the injury returning.
Use sports massage techniques. This will help prevent adhesions forming within the tendon. These adhesions stop the tendon sliding smoothly in its sheath.
Sports massage should also be used on the calf muscles themselves to aid in improving the flexibility and general condition of these muscles.
3. Strengthening
The aim is to strengthen the calf muscles and the achilles tendon. It is important that you strengthen the tendon in the stretched position.
There has been a lot of research into strengthening exercises during the rehabilitation of achilles tendinitis. The current concept is based around eccentric contractions. These are muscle contractions where the muscle lengthens to control a downward movement.
Heel drops and raises are used in the rehabilitation of achilles tendonitis.
Particular emphasis should be placed on the downward phase as this is the eccentric contraction.
The following strengthening guide is intended for information purposes only. We recommend seeking professional advice before attempting any self help treatment.
Strengthening should be done in conjunction with stretching and only when the tendon is free from pain and inflammation. Start with the easier exercises. When they become too easy, replace them with a more difficult exercise. Do not do all the exercises at once.
Resistance Band Plantarflexion
-----------------------------------
This is a gentle exercise to start with. Hold a loop of resistance band and use it to apply resistance as you point the foot away.
Start with just 2 sets of 10 once a day and build up to 3 sets of 20.
If it does not hurt the next day then increase the load.
You may find with this one you can increase the resistance quite quickly.
Seated Calf Raise
--------------------
Again this is a gentle exercise but this one will strengthen the Soleus muscles.
Sit on a chair and raise up onto you toes.
Start with 2 sets of 10 twice a day and increase a little every two or three days when you are sure there has been no adverse reaction (pain).
4. Improving Proprioception (neural co-ordination)
It is possible that the neural control or co-ordination of the ankle has been affected, especially if the injury has been severe and required a sustained period of rest.
Balancing on one leg is a good way of developing proprioception. This will help prevent spraining the ankle in future and is a good all round strengthening exercise for the ankle. Aim for 2 minutes without wobbling. To challenge the ankle even further, a wobble board can be used.
5. Returning to Full Fitness
When you have gone at least a week without pain and the range of motionat the ankle has improved then you can begin to return to training.
If you feel pain when returning to training then stop. Begin each training session with a walk to warm up followed by stretching.
After training apply ice or cold therapy to the tendon for 10 minutes to help prevent inflammation from returning.
Day 1: walk 4 minutes jog 1 minutes repeat four times
Day 2: rest
Day 3: walk 4 minutes jog 2 minutes repeat three times
Day 4: rest
Day 5: walk 3 minutes jog 3 minutes repeat 4 times
Day 6: rest
Day 7: walk 2 minutes jog 4 minutes repeat 4 times
Continue this gradual progression until you can confidently run and resume normal training.
Gradually increase the duration of your runs. No more than 10% increase per week is the usual recommendation.
If your sport demands sprinting then gradually increase the speed.
Continue with the stretching and strengthening programmes. It is important to do these even if you do not feel pain at this stage. Continue for at least three months.
Continue to ice the tendon after training.
You should now be ready to start back in full training but never neglect stretching and strengthening of the achilles tendon or the injury might return.
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These are important muscles for walking. This tendon can become inflamed, most commonly as a result of overuse or arthritis. Inflammation can also occur with injury and infection.
Tendinitis due to overuse is most common in younger people. It can occur in walkers, runners, or other athletes. Sports like basketball that involve jumping put a large amount of stress on the Achilles tendon. Repeated jumping can lead to Achilles tendinitis.
Achilles tendinitis may be more likely to occur:
After a sudden increase in the amount or intensity of an activity
When the calf muscles are very tight (not stretched out)
Tendinitis from arthritis is more common in middle-aged and elderly people. A bone spur or growth may form in the back of the heel bone. This may irritate the Achilles tendon and cause pain and swelling.
Symptoms
Symptoms include pain in the heel and along the tendon when walking or running. The area may feel painful and stiff in the morning.
The tendon may be painful to touch or move. The skin over the tendon may be swollen and warm. You may have trouble standing up on one toe.
Exams and Tests
The doctor will perform a physical exam. The doctor will look for tenderness along the tendon and pain in the area of the tendon when you stand on your toes.
X-rays can help diagnose arthritis.
An MRI scan may be done if your doctor is thinking about surgery or is worried about the tear in the Achilles tendon.
Treatment
The main treatments for Achilles tendinitis do not involve surgery. It is important to remember that it may take at least 2 to 3 months for the pain to go away.
Try putting ice over the Achilles tendon for 15 to 20 minutes, two to three times per day. Remove the ice if the area gets numb.
Changes in activity may help manage the symptoms:
Decrease or stop any activity that causes you pain.
Run or walk on smoother and softer surfaces.
Switch to biking, swimming, or other activities that put less stress on the Achilles tendon.
Your health care provider or physical therapist can show you stretching exercises for the Achilles tendon.
They may also suggest the following changes in your footwear:
A brace or boot to keep the heel and tendon still and allow the swelling to go down
Heel lifts placed in the shoe under the heel
Shoes that are softer in the areas over and under the heel cushion
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen can help with pain or swelling. Talk with your health care provider.
If these treatments do not improve symptoms, you may need surgery to remove inflamed tissue and abnormal areas of the tendon. Surgery also can be used to remove the bone spur that is irritating the tendon.
Extracorporeal shock wave therapy (ESWT) may be an alternative to surgery for people who have not responded to other treatments. This treatment uses low-dose sound waves.
Outlook (Prognosis)
Lifestyle changes usually help improve symptoms. However, symptoms may return if you do not limit activities that cause pain, or if you do not maintain the strength and flexibility of the tendon.
Surgery, if needed, has been shown very effective for improving pain.
Possible Complications
Achilles tendinitis may make you more likely to have an Achilles rupture. This condition usually causes a sharp pain, like someone hit you in the back of the heel with a stick. Surgical repair is necessary, but difficult because the tendon is not normal.
When to Contact a Medical Professional
If you have pain in the heel around the Achilles tendon that is worse with activity, contact your health care provider for evaluation and possible treatment for tendinitis.
Prevention
Prevention is very important in this disease. Maintaining strength and flexibility in the muscles of the calf will help reduce the risk of tendinitis. Overusing a weak or tight Achilles tendon makes you more likely to develop tendinitis.
Alternative Names
Tendinitis of the heel
The following rehabilitation guide is intended for information purposes only. We recommend seeking professional advice before attempting any self help treatment.
Aims of Rehabilitation
---------------------------
1. Decrease initial pain and inflammation.
2. Improve flexibility.
3. Improve the strength of the joint.
4. Re-establish neural control and co-ordination.
5. Return to full fitness.
1.Decreasing Pain and Swelling
This is the first stage of treatment, which can last for anywhere from 3 days to several weeks, depending on the severity of your condition.
Cold therapy - apply for 15 minutes at least three times a day. Every two hours if possible for the first day.
Identify the cause of the injury. Training too much too soon, training on hard surfaces, wearing the wrong shoes or shoes that are too old and not warming up are possible reasons for the injury occurring. Also, if you overpronate, the Achilles is twisted putting more strain on it.
Rest - use crutches if needed.
Place a heel lift of about 1cm into both your shoes to help take the stress off the tendon. Do not leave it there forever! If the calf muscles adaptively shorten, an increased strain will be placed on the achilles tendon in the future.
Anti-inflammatory medication can be taken (under Doctors advice of course).
Maintain fitness by non weight bearing exercise such as cycling if pain allows.
2. Improving Flexibility
Once you can perform daily activities pain-free, move on to this stage.
Concentrate on improving the flexibility of the calf muscles (Gastrocnemius and Soleus). This will reduce the strain on the achilles tendon.
Two stretches in particular are important, one with a straight leg for the Gastrocnemius muscle and one with the leg bent to target the Soleus muscle.
Stretching should be done regularly, three times a day initially and should be maintained long after the injury has healed to prevent the injury returning.
Use sports massage techniques. This will help prevent adhesions forming within the tendon. These adhesions stop the tendon sliding smoothly in its sheath.
Sports massage should also be used on the calf muscles themselves to aid in improving the flexibility and general condition of these muscles.
3. Strengthening
The aim is to strengthen the calf muscles and the achilles tendon. It is important that you strengthen the tendon in the stretched position.
There has been a lot of research into strengthening exercises during the rehabilitation of achilles tendinitis. The current concept is based around eccentric contractions. These are muscle contractions where the muscle lengthens to control a downward movement.
Heel drops and raises are used in the rehabilitation of achilles tendonitis.
Particular emphasis should be placed on the downward phase as this is the eccentric contraction.
The following strengthening guide is intended for information purposes only. We recommend seeking professional advice before attempting any self help treatment.
Strengthening should be done in conjunction with stretching and only when the tendon is free from pain and inflammation. Start with the easier exercises. When they become too easy, replace them with a more difficult exercise. Do not do all the exercises at once.
Resistance Band Plantarflexion
-----------------------------------
This is a gentle exercise to start with. Hold a loop of resistance band and use it to apply resistance as you point the foot away.
Start with just 2 sets of 10 once a day and build up to 3 sets of 20.
If it does not hurt the next day then increase the load.
You may find with this one you can increase the resistance quite quickly.
Seated Calf Raise
--------------------
Again this is a gentle exercise but this one will strengthen the Soleus muscles.
Sit on a chair and raise up onto you toes.
Start with 2 sets of 10 twice a day and increase a little every two or three days when you are sure there has been no adverse reaction (pain).
4. Improving Proprioception (neural co-ordination)
It is possible that the neural control or co-ordination of the ankle has been affected, especially if the injury has been severe and required a sustained period of rest.
Balancing on one leg is a good way of developing proprioception. This will help prevent spraining the ankle in future and is a good all round strengthening exercise for the ankle. Aim for 2 minutes without wobbling. To challenge the ankle even further, a wobble board can be used.
5. Returning to Full Fitness
When you have gone at least a week without pain and the range of motionat the ankle has improved then you can begin to return to training.
If you feel pain when returning to training then stop. Begin each training session with a walk to warm up followed by stretching.
After training apply ice or cold therapy to the tendon for 10 minutes to help prevent inflammation from returning.
Day 1: walk 4 minutes jog 1 minutes repeat four times
Day 2: rest
Day 3: walk 4 minutes jog 2 minutes repeat three times
Day 4: rest
Day 5: walk 3 minutes jog 3 minutes repeat 4 times
Day 6: rest
Day 7: walk 2 minutes jog 4 minutes repeat 4 times
Continue this gradual progression until you can confidently run and resume normal training.
Gradually increase the duration of your runs. No more than 10% increase per week is the usual recommendation.
If your sport demands sprinting then gradually increase the speed.
Continue with the stretching and strengthening programmes. It is important to do these even if you do not feel pain at this stage. Continue for at least three months.
Continue to ice the tendon after training.
You should now be ready to start back in full training but never neglect stretching and strengthening of the achilles tendon or the injury might return.
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