Achilles tendonitis is diagnosed by a history and physical examination of the patient who describes pain at the back of the ankle with walking and/or running activities. The pain generally will be associated with an increase in running or jumping intensity or frequency. The pain from Achilles tendonitis is often so severe that running is impossible and even walking is uncomfortable.
Must Know About This
- Surgery is rarely indicated .
- There is non-surgical treatment that works.
- Responds very well to conservative treatment as long as it is diagnosed and treated early.
Good to Know About This
- Diagnosed by a history and physical examination.
- Most Common in older active adults. May occur in teenagers active in running and jumping.
- Stretching can help, but this often aggravates Achilles tendonitis.
More About This
The Achilles tendon is the largest tendon in the human body. It is located at the back of the ankle joint and can be felt as a large, cord-like structure attaching to the back of the foot. Since tendons serve to attach muscles to bone, the Achilles tendon also attaches the large calf muscles, the gastrocnemius and soleus, to the back of the heel bone, the calcaneus.
The muscle mass and strength of the gastrocnemius and soleus muscles are greater than all of the other muscles of the lower leg combined. Therefore, the pull of these muscles on the Achilles tendon is very large since these muscles help balance the body while standing, push the body forward during walking, spring the body forward during running, and spring the body upward during jumping. Because of the large amount of stress which the Achilles tendon is subjected to during running and jumping activities, the Achilles tendon is prone to The most common form of injury to the Achilles tendon is called Achilles tendonitis, which is an inflammatory condition causing pain in the Achilles tendon. Achilles tendonitis generally occurs in people who are active in sports activities. Types of sports that commonly are associated with Achilles tendonitis are basketball, tennis, running, football, soccer, volleyball and other running and jumping sports.
Achilles tendonitis tends to occur more frequently in older athletes than in younger athletes. As a person ages into their thirties and especially into their forties and fifties, the ligaments and tendons of the body tend to lose some of their stretchiness and are not as strong as before. This predisposes older individuals who are active in running and jumping activities, to tendon injuries such as Achilles tendonitis. However, Achilles tendonitis can also occur in teenagers who are very active in running and jumping sports.
Achilles tendonitis is diagnosed by a history and physical examination of the patient who describes pain at the back of the ankle with walking and/or running activities. The pain generally will be associated with an increase in running or jumping intensity or frequency. It is also often associated with a change from running in a thick heeled shoe to a thin heeled shoe, such as going from training shoes to racing flats and/or racing spikes in cross-country and/or track. The pain from Achilles tendonitis is often so severe that running is impossible and even walking is uncomfortable.
During the physical examination, the podiatrist will feel and push lightly around the Achilles tendon to see if it is tender or has any irregularities in its surface. Achilles tendonitis may cause the tendon to be thickened in areas, may cause swelling of the area around the tendon, and can even feel like the tendon has a painful bump on it. In addition, the person with Achilles tendonitis will limp while barefoot, but walk more normally with heeled shoes on. X-rays are not helpful in diagnosing Achilles tendonitis but may be taken to rule-out other pathology. MRI scans are only indicated if a partial or complete rupture of the Achilles tendon is suspected by the podiatrist.
Achilles tendonitis generally responds very well to conservative treatment as long as it is diagnosed and treated early. Surgery is rarely indicated unless the Achilles tendonitis is particularly severe and chronic, or if the tendon has ruptured completely.
Initially, the podiatrist may treat the Achilles tendonitis by putting heel lifts into the patient’s shoes. In addition, the patient may be asked to avid barefoot walking or walking in low-heeled shoes. Non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin, Advil) and naproxen (Naprosyn, Aleve) may also be prescribed to calm the inflammatory process in the tendon. Icing may be suggested to help decrease the inflammation and pain in the tendon. Stretching exercises for the calf muscles may also be given to the patient to help loosen the calf muscle and Achilles tendon so that the tendon is not under as much stress during normal daily walking activities. The stretching should not be done however if it causes pain in the Achilles tendon.
Initially, the patient with Achilles tendonitis will be asked to modify their activities to decrease their running and jumping activities and do alternative physical activities, such as swimming, which don’t put as much stress on the Achilles tendon. As the tendon starts to feel better, the podiatrist will allow a gradual return to normal running and jumping activities. If normal return to activities is not possible within a few weeks, then many times the podiatrist may additionally prescribe physical therapy and/or functional foot orthotics to help the tendon heal more rapidly. The foot orthotics generally are used during both the sports activities and walking activities to allow for more normal foot and Achilles tendon function. If the physician is concerned about a partial tear of the tendon the patient may be placed in a below the knee cast. It can take several weeks or even months for the tendon to heal depending upon the severity of the injury to the tendon. It is not uncommon for a patient to return to activities too quickly and re-injure the tendon. Careful monitoring of a return to full activity is important and the patient must have patience during this period of time.
Achilles tendonitis and spurs have a non-surgical treatment that works.
If you have pain in the back of your heel and are thinking about having an invasive surgical procedure – STOP.
There is a proven treatment that works for permanently relieving the pain using sound waves.
The sound waves actually are shock waves and now using the same technology that dissolves kidney stones, your heal can be treated in one 20 min treatment.
This technology is proven. With literally 100?s of articles that support cure rates of 70 to 95% published in the past 10 years, there is no disputing this technology and its results.
How does it work?
The machines produce high intensity shockwaves that are delivered into the back of the heel. In a single treatment session, 3200 shocks are delivered. The patient does not feel pain during the treatment. (local anesthesia is used) The treatment takes 20 min. The patient walks out of the office and can walk normally the next day in regular shoes.
What is happening here?
The Achilles tendon hurts when too much stress is put on it. Stress can come from overuse, or lack of stretching resulting in tightness of the tendon. The pain can exist at the insertion of the tendon or slightly higher. In either case, a spur can be located at the insertion. An x-ray can be used to see if you have a spur.
What does it mean if you have a spur?
Spurs are a sign that there has been excessive pulling on a bony insertion over a long period of time. Sometimes spurs are very large and sometime small. Sometimes spurs are located on the bottom of the foot and the back of the heel. This is because a tight Achilles tendon can pull back on the heel helping to actually create plantar heel pain (plantar fasciitis) and sometimes flattening the foot.
Stretching can help, but this often aggravates Achilles tendonitis.
Resting can help and should be tried as a conservative treatment.
Is there any other NEW treatment that can help this problem?
YES. PEMF pads are electromagnetic therapy pads that can be worn at night or during the day. These really work well at improving blood flow.
Is there any NEW surgical information or alternatives?
YES – the Topaz Procedure.
The Endocspic Gastrocenemious Recession is fast becoming a procedure of choice for the treatment of Achilles tendonitis and plantar fasciitis in patients with over tight leg muscles. Often, the tight gastroc is overlooked by the foot professional at a primary cause of foot deformity and pain. Testing for this is very simple: dorsiflex the foot with the knee extended. If you do not have at least 10 degrees of dorsiflexion, then you are tight.
The EGR is simple to perform (less than 15 min) and is done under local anesthesia. It is performed through two very small 1 cm incisions in the back of the leg. As an endoscope is place into one of the incisions, a special blade is used to separate the aponeurotic band that joins the gastroc muscle to the tendon. See Photo.
The advantages are numerous: small incisions. Fast healing time to most activities in 3 weeks. Walking right away in surgical boot for 1-2 weeks and then tennis shoes.
Many other biomechanical advantages are obtained with EGR surgery. These include less forefoot pain, slows down deformity of forefoot bunions and hammertoes. Improves many forms of flat foot.
The EGR is now performed in place of Achilles tendon lengthening procedures closer to insertion. This is because of the lengthy healing time (6 months) for the Achilles tendon and increased risk of post op traumatic tearing with procedures performed close to the insertion.
Can the ECSW non-invasive shock wave procedure cure Achilles tendonitis without surgery?
YES. The ECSW is much better at treating insertional tendonitis vs high tendonitis. But it does work for tendonitis. See illustration for identification of high tendonitis vs insertional tendonitis.
What type of person usually gets insertional tendonitis of the Achilles?
Usually heavier people with have larger spurs on the back of the heel. But many different body types have this problem.
Why Feet for Life Centers?
Dr. Michael Horwitz performes more of these procedures than anyone in the Midwest. Averaging 5 EGR’s a week on children and adults. Knowing what to look for and how to perform this procedure non-traumatically takes practice. Dr. Horwitz is a true leader in the treatment of heel pain. Feet for life Drs have performed over 450 ECSW procedures in the past 5 years and lead the country in the treatment of heel pain with this modality.
- reducing your physical activity.
- switching to low-impact exercises, such as swimming.
- very gently stretching and later strengthening your calf muscles.
- icing the area after exercise or when in pain.
- elevating your foot to decrease any swelling.
- Rest your leg. ...
- Ice it. ...
- Compress your leg. ...
- Raise (elevate) your leg. ...
- Take anti-inflammatory painkillers. ...
- Use a heel lift. ...
- Practice stretching and strengthening exercises as recommended by your doctor, physical therapist, or other health care provider.
Most cases of Achilles tendinitis can be treated with relatively simple, at-home care under your doctor's supervision. Self-care strategies are usually necessary to prevent recurring episodes. More-serious cases of Achilles tendinitis can lead to tendon tears (ruptures) that may require surgical repair.
How long does Achilles tendinopathy last? It can take weeks or even months to recover from Achilles tendinopathy. For most people, the pain and movement get better after around 12 weeks of self-help measures and physiotherapy exercises. But other people may need more specialist treatments.
If a completely ruptured Achilles tendon is not treated properly, it may not heal or heal with scar tissue in an elongated position, and the person will not regain enough strength in the leg for normal daily activities such as walking, let alone running or other athletic activities.
Achilles tendinopathy is a common condition, particularly in those who run. It is a chronic, activity-limiting syndrome, defined by the presence of pain and thickening in the Achilles tendon (Figure 11).
- Rest: Stop doing activities that stress your tendon. ...
- Ice: Put ice on your tendon for up to 20 minutes, as needed throughout the day.
- Compression: Compress, or put pressure on, the tendon using an athletic wrap or surgical tape.
Full body immersion cryotherapy and localized cryotherapy can both be used to speed up tendon injury healing. The extreme cold stimulates blood flow, tissue regeneration, and boosts tendon healing.
Even fast walking would likely be ok - but if too painful, try using an insert in the heel (available at most drug stores). This shortens the length of the Achilles tendon and relieves some of the stress.
If left unattended, the tendon will not heal on its own and you will have lasting repercussions. In such situations, a surgeon will access the injured tendon, perform repairs, and close the incision. This will be followed by several weeks of rest and physical therapy so you can heal and strengthen your body.
You might need Achilles tendon surgery if you tore your tendon. Surgery is advised for many cases of a ruptured Achilles tendon. But in some cases, your healthcare provider may advise other treatments first. These may include pain medicine, or a temporary cast to prevent your leg from moving.
“Once a tendon is injured, it almost never fully recovers. You're likely more prone to injury forever.”
Untreated Achilles tendonitis can lead to a series of tears within the tendon, making it susceptible to rupture. A rupture of the tendon will most likely require more serious treatment options, including casting or surgery.
As "overuse" disorders, Achilles tendonitis and tendonosis are usually caused by a sudden increase of a repetitive activity involving the Achilles tendon. Such activity puts too much stress on the tendon too quickly, leading to micro-injury of the tendon fibers.
There are a few injection techniques available for treating mid-portion Achilles tendinopathy. These are reserved for cases that are not improving with exercise based physiotherapy. All these injections are designed to be carried out alongside your rehabilitation exercises. Injections are not stand-alone treatments.
The more severe the tendinopathy, the less likely stretching would help. In fact, stretching results in further compression of the tendon at the irritation point, which actually worsens the pain.
Loading of the tendon (applying weight or resistance to it) through exercise is beneficial for recovery from Achilles tendinopathy. You may begin by performing gentle strengthening exercises in a seated position (eg, pushing and pulling on a resistive band with your foot).
Conclusion: Pressure massage is a useful treatment for Achilles tendinopathy. Compared with eccentric exercise treatment, pressure massage gives similar results.
Left untreated, the condition usually progresses to a degeneration of the tendon (Achilles tendonosis), in which the tendon loses its anatomic structure and is likely to develop tendon tears. In some cases, the degeneration may result in a complete rupture of the tendon.
With rest, Achilles tendonitis usually gets better within 6 weeks to a few months. To lower your risk of Achilles tendonitis again: Stay in good shape year-round.
A Treatment Regimen
The rest, ice, compression, elevation (RICE) method and anti-inflammatory medicines or ointments can help. Martin favors contrast baths: immersing the affected area in warm water with Epsom salt for 10 minutes and then cold water with no more than four ice cubes for 10 minutes.
Rest and ice can ease the pain of tendinitis. Stay off your foot or ankle as much as possible and apply ice for up to 15 minutes at a time, three to four times a day. Stretching of the tendon is not recommended until all symptoms have resolved or indicated by your physician.
Achilles tendinitis is a common condition that causes pain along the back of the leg near the heel. The Achilles tendon is the largest tendon in the body. It connects your calf muscles to your heel bone and is used when you walk, run, and jump.
The Achilles tendon is the largest tendon in the body.. Achilles tendinitis is different than an Achilles rupture, a condition where the tendon becomes separated off the heel bone or completely torn in half.. This article will focus on Achilles tendinitis rather than Achilles tendon rupture .. Insertional Achilles tendinitis involves the lower portion of the tendon, where it attaches (inserts) to the heel bone (also known as the calcaneus).. Calf muscle tightness puts extra stress on the Achilles tendon, especially where it inserts into the heel bone.. Pain and stiffness along the Achilles tendon in the morning Pain along the tendon or back of the heel that worsens with activity Severe pain the day after exercising Thickening of the tendon Bone spur formation (insertional tendinitis) Swelling that is present all the time and gets worse throughout the day or with activity Pain on the back of the heal when you wear shoes. Swelling along the Achilles tendon or at the back of your heel Bone spurs or pain near the lower part of the tendon at the back of your heel (insertional tendinitis) Pain in the middle of the tendon, (noninsertional tendinitis) Heel pain when stretching your calf Limited range of motion in your ankle — specifically, a decreased ability to point your toes downward. While injections can be used in other injuries and conditions, cortisone injections into the Achilles tendon are not recommended because they can cause the tendon to rupture (tear).. Extracorporeal Shockwave Therapy (ESWT) This therapy uses either low- or high-energy shockwaves applied to the Achilles tendon to promote healing of the damaged tendon tissue.. For insertional Achilles tendinitis, removal of the bone spurs from the heel in addition to the damaged tendon tissue is commonly performed with good outcomes.. In cases where more than 50% of the Achilles tendon must be removed, the remaining portion of the tendon is not strong enough to function alone.. For Achilles tendinitis, it may involve using small incision to place a camera and small instruments through the skin to remove damaged and inflamed Achilles tendon tissue.
Achilles tendonitis or achilles tendinopathy is inflammation or more likely degeneration of the achilles tendon. It can be acute or chronic.
Achilles tendonitis is an overuse injury causing pain at the back of the ankle.. Achilles tendonitis is either acute or chronic.. Acute Achilles tendonitis symptoms develop over a few days and become chronic if not treated correctly.. Pain and stiffness in the Achilles tendon.. Achilles tendonitis, Achilles tendinopathy or Achilles tendinosis is an overuse injury resulting in pain, inflammation or degeneration of the Achilles tendon.. Tendonitis suggests inflammation of the tendon (‘itis’ means inflammation).. Achilles tendonitis heel drop exercises have proven to be very successful for chronic Achilles tendon pain.. Achilles tenosynovitis (also known as paratenonitis) is an inflammatory condition of the sheath or layer surrounding the Achilles tendon It is an overuse injury that…. Insertional Achilles Tendonitis causes pain at the back of the heel at the point where the Achilles tendon inserts into the heel bone.
Poor flexibility of the Achilles tendon can lead to inflammation and even rupture. Learn more about the causes and treatment of Achilles pain.
The two most common causes of Achilles tendon pain are Achilles tendonitis and Achilles tendinosis.. Achilles Tendon Rupture. It's important to seek out medical attention if you develop pain in the back of your leg, anywhere from your heel to your calf.. A thorough physical exam of your foot and ankle can help determine what is behind your Achilles tendon pain.. A healthcare provider can sometimes diagnose an Achilles tendon rupture by feeling the tendon.. When you see a healthcare provider for Achilles tendon pain, they will consider several other conditions.. Blood tests may help if a healthcare provider is worried about an infection in the heel bone or in the skin near the tendon.. They also may help in the immediate care of a possible Achilles tendon rupture.. Be sure to do gentle calf stretches after exercise, when the muscle and tendon are still warm and flexible.. For Achilles tendonitis, it's a good idea to begin exercises that strengthen the calf muscle as soon as your healthcare provider thinks you're ready.. Surgery may be needed for an Achilles tendon rupture.. If it's not treated, you may develop the more serious and chronic condition of Achilles tendinosis.. The sudden, severe pain of an Achilles tendon rupture requires immediate medical attention.
Your Achilles tendon withstands a lot of stress and pressure during everyday activities, as well as during athletic and recreational play.
The Achilles tendon can also tear or rupture, which might sound like a “pop” that seems to come from the back of your heel or calf.. Anyone can develop an Achilles tendon injury and it’s often linked to repetitive stress on the tendon.. Achilles tendon injuries often cause pain, stiffness, and swelling in the back of your leg near your heel.. Tight calf muscles when starting an exercise or sport, this can place more stress on your tendon. Common symptoms of tendon injuries include:. Pain that gets worse when you're active. Injury to the Achilles tendon causes pain along the back of your leg near the heel.. Several common injuries can make your Achilles tendon painful or prevent it from working well.. Your doctor will use MRI most often to see how severe the tendon damage is and what treatment is best for you.. The type of surgery depends on the location and amount of damage to the tendon and other factors, such as the severity of the tendonitis.. Debridement surgery to remove damaged tendon tissue or bone spurs and repair the tendon. Complications of an Achilles tendon injury may include:. Other complications can be related to the treatments used for an Achilles tendon injury.. Stop activities that cause pain.
The Achilles tendon runs down the back of the lower leg and joins the calf muscles to the heel bone. It is the largest tendon in the body and is very strong. Running and other high impact activities can inflame the Achilles tendon, causing pain. Learn how to treat it with stretches, exercise, medication, and rest.
The Achilles tendon joins the calf muscles to the heel bone and runs down the back of the lower leg.. The Achilles tendon is the largest tendon in the body.. Achilles tendinitis , or tendonitis, usually results from microtears that occur in the tendon during strenuous, high impact exercise, such as running.. Surgery can repair the damage sustained by the tendon as a result of Achilles tendinitis.. Achilles tendinitis can lead to Achilles tendinosis , a degenerative condition in which the structure of the tendon changes and becomes susceptible to serious damage.. Using incorrect or worn out shoes when running or exercising Not warming up properly before exercise Increasing intensity of exercise too quickly, for example, running speed or distance covered Prematurely introducing hill running or stair climbing to an exercise routine Running on hard or uneven surfaces The calf muscle is injured or has little flexibility, putting more strain on the Achilles tendon Sudden intense physical activity such as sprinting for the finish line. Varying exercise: Alternating between high-impact exercises, such as running, and low-impact exercise, for example, swimming, can reduce stress on the Achilles tendon on some days.. Gradually increasing the intensity of a workout : Achilles tendinitis can occur when the tendon is suddenly put under too much strain, so warming up and increasing the level of activity gradually gives the muscles time to loosen up, and this puts less pressure on the tendon.. Stretching helps to keep the Achilles tendon flexible, so there is less chance of tendinitis developing.
Achilles tendinopathy or tendonitis is a condition that causes pain of the Achilles tendon. Click through for advice on treatment and other information.
Achilles tendinopathy is a condition that causes pain, swelling and stiffness of the Achilles tendon.. This means that over time, damage to the Achilles tendon builds up and Achilles tendinopathy can develop.. Achilles tendinopathy used to be known as Achilles tendonitis.. The main symptoms include pain and stiffness around the affected Achilles tendon.. Your doctor will usually diagnose Achilles tendinopathy because of your typical symptoms and from examining your Achilles tendon.. Ice treatment may be useful for pain control and may help to reduce swelling in the early stages of Achilles tendinopathy.. They may also use other treatments such as ultrasound and massage to help relieve symptoms and promote healing of your Achilles tendon.. If steroids are injected directly into the Achilles tendon, there is a risk of damaging the tendon further.. This procedure is generally safe but there is a small risk of tearing (rupturing) the Achilles tendon with this treatment, particularly in older people.. There is a risk of tearing (rupturing) your Achilles tendon if you have Achilles tendinopathy.. Severe pain around the Achilles tendon that develops suddenly may be a sign of tendon rupture.
Achilles tendon repair surgery is a type of surgery to fix a damaged Achilles tendon. This is the strong, fibrous cord in the lower leg that connects the muscles of your calf to your heel. It’s the largest tendon in your body.
Achilles tendon repair surgery is a type of surgery to fix a damaged Achilles tendon.. If the tendon is degenerated, the surgeon may remove the damaged part of the tendon and repair the rest of the tendon with stitches.. If there is severe damage to a lot of the tendon, the surgeon might replace part or all of your Achilles tendon.. In some cases, the Achilles tendon repair surgery can be done as a minimally invasive procedure.. You might need Achilles tendon surgery if you tore your tendon.. Surgery is advised for many cases of a ruptured Achilles tendon.. Or you may need Achilles tendon repair surgery if you have tendinopathy.. Your own risks may vary according to your age, the shape of your foot and leg muscles and tendons, your general health, and the type of surgery done.. Talk with your healthcare provider how to prepare for your surgery.. Achilles tendon surgery can be done with several methods.. The surgery is done by an orthopedic surgeon and a team of specialized healthcare providers.. Ask your healthcare provider about the details of your surgery.. Achilles tendon surgery is often an outpatient procedure.. About 10 days after your surgery, you’ll need to return to your healthcare provider to have your stitches removed.. The name of the test or procedure The reason you are having the test or procedure What results to expect and what they mean The risks and benefits of the test or procedure What the possible side effects or complications are When and where you are to have the test or procedure Who will do the test or procedure and what that person’s qualifications are What would happen if you did not have the test or procedure Any alternative tests or procedures to think about When and how will you get the results Who to call after the test or procedure if you have questions or problems How much will you have to pay for the test or procedure
Achilles tendon pain can result from tendonitis or a tear or rupture of the tendon. Problems with the Achilles tendon are more common in people who play sports. They typically occur from excessive use of the calf muscles but can also result from acute injuries. Learn more about Achilles tendon pain here.
Pain in this tendon can result from a tear or rupture of the tendon or from tendinitis, which doctors may also refer to as tendinosis or tendinopathy.. The two main causes of Achilles tendon pain are a tear or rupture to to the tendon and tendinitis .. It is possible for a person to tear the fibers of an Achilles tendon.. a popping or snapping sound at the time of the injury pain in the heel or back of the leg pain that worsens when moving the ankle or foot swelling around the heel stiffness in the legs and heel difficulty walking or moving the foot. Symptoms of Achilles tendinitis can include :. Treatment for Achilles tendon pain depends on the type and severity of the injury.. For people with mild injuries, treatment typically involves:. Causes of Achilles tendon pain include Achilles tendinitis and tears or ruptures to the tendon.. These conditions are common in people who play sports and typically occur from excessive use of the calf muscles but can also result from acute injuries.. Factors that can increase a person’s risk of injuring an Achilles tendon include sudden changes in type or intensity of physical intensity, inappropriate footwear, or being overweight.. Treatment options for Achilles injuries include rest and physical therapy.. For people with more severe injuries, a doctor may recommend surgery.
Learn more from WebMD about Achilles tendon injuries, including their causes, symptoms, diagnosis, treatment, and prevention.
It stretches from the bones of your heel to your calf muscles.. This affects the lower part of your heel, where your tendon inserts, or goes into, your heel bone.. These things may make you more likely to get an Achilles tendon injury:. To make the right diagnosis, your doctor will start with a physical exam.. You can still be active while your injury heals.. Medscape: “Achilles Tendon Injuries,” “Complete Ruptures of the Achilles Tendon.”