What is Achilles tendinitis?
Achilles tendinitis is painful and fairly common condition caused from inflammation, irritation or degeneration of the Achilles tendon - the large tendon that runs down the back of the lower leg.
Are there different types of Achilles tendinitis?
There are two types of Achilles tendonitis: insertional and non-insertional.
Insertional Achilles tendonitis affects the lower portion of the Achilles tendon, where it attaches to the heel. Small tears and swelling are typical of this type of Achilles tendonitis and it is common in people with a Haglund’s deformity, a foot condition where the back of the heel is prominent, which causes irritation to the tendon.
Non-insertional Achilles tendonitis is characterized by pain and inflammation of the middle portion of the Achilles tendon. It can result in degeneration of the tissue due to stress and pull of the tendon. Non-insertional Achilles tendonitis is more commonly seen in young, active people.
What causes Achilles tendinitis?
Generally speaking, Achilles tendonitis is caused by repetitive stress and overuse. It can also be cause by an increase in physical activity that takes place too rapidly. However, there are other possible causes as well such as a pre-existing foot problem, an abnormal bone growth, improper footwear, tight muscles or tendons, and even foot biomechanics such as over pronation.
What are its symptoms? How do you know if you have it?
Below is a list of the most common symptoms of Achilles tendonitis:
- Pain and stiffness along the Achilles tendon or the back of the heel, often most significant in the morning
- Pain and swelling along the tendon or heel that worsens with activity
- Thickening or swelling of the tendon
- A boney protrusion or bone spur at the back of the heel (insertional tendinitis)
- Severe pain the day after exercising
How is Achilles tendinitis diagnosed?
Doctors will typically order an x-ray to check for calcification or bone growth in the tendon. The x-ray can show which part of the Achilles tendon has calcified. When the lower part of the tendon is calcified, it indicates insertional Achilles tendinitis. When the middle section of the Achilles tendon becomes calcified, it indicates severe non-insertional Achilles tendinitis.
In some cases, the doctor might order an MRI. MRIs are used when the doctor is concerned possible large tears to the tendon. MRIs can show the level of damage to the tendon and help the doctor plan for surgery, as the type of surgery will depend on how severe the damage.
How do you prevent Achilles Tendinitis?
One of the most important questions asked about Achilles tendinitis is how to prevent it. Here are a few steps you can take to lower your risk of developing this foot condition.
- Avoid overtraining and exercising. Rather, gradually increase the intensity and length of your training time.
- Avoid running on soft surfaces such as sand or grass for extended periods of time. The softer surfaces cause the heel of the foot to drop down more than they would on a hard surface, which in turn causes more stress on the tendon.
- Make sure you follow a proper warm-up routine before exercising and that you do your stretches not only before and after exercising, but on your rest days as well.
- Make sure you use proper footwear. Don’t use old, worn out shoes that don’t provide adequate support. Insufficient support can increase stress on the Achilles tendon.
- If you over pronate, you should use a special type of shoe that helps correct overpronation and comes with: a. firm heel counter, which reduces overpronation. b. orthotic insoles with good arch support. c. Shoes that are softer at the back of the heel can reduce friction and irritation of the tendon.
- Shoes with ergonomic soles design that provide a heel lift help reduce strain on the tendon.
- For shoes that don’t provide adequate orthopedic features, orthotic insoles with anatomical arch support and heel lift are commonly used to treat Achilles Tendinitis.
Orthofeet has a wide variety of shoes and orthotics that can help with over-pronation and reduce strain on the Achilles tendon.
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What are the treatment options?
There are both nonsurgical and surgical treatment options. Obviously, surgical treatment is a last resort and should only be considered after nonsurgical treatment has been attempted for at least six months.
Let’s start with nonsurgical treatment options:
Rest. Top on the list of treatment options is rest. This means either stopping completely or at least decreasing the activities that deepen the pain.
Ice. Icing the painful area of the Achilles tendon is another helpful option. This can be done whenever it is convenient throughout the day and can be done in up to 20-minute intervals.
Calf stretch. Calf stretches are a good exercise to perform because it helps strengthen the calf muscles and reduces stress on the Achilles tendon.
Supportive shoes and orthotics. Shoes that are softer at the back of the heel can reduce friction and irritation of the tendon. Shoes that incorporate Heel lifts can also help reduce strain on the tendon.
Click here to learn more how Orthofeet shoes can help with Achilles tendon symptoms.
Physical therapy. Physical therapy can be very effective in treating Achilles tendinitis. A good physical therapist can show you how to follow an eccentric strengthening program – a muscle tightening exercise for building strength and releasing stress. It’s important, however, that a licensed PT show you how to perform these types of exercises, since doing them incorrectly can cause damage to the tendon.
Non-steroidal anti-inflammatory medication. These types of drugs can help reduce pain and swelling, during the recovery process, but they do not actually treat the degeneration of the tendon.
Now for surgical options:
The type of surgery performed depends on the severity of the damage to the tendinitis and its location. There are several types of surgical options.
- 1. Debridement and repair – this surgery is only performed when there is less than 50% damage to the tendon. In this operation, the damaged part of the tendon is removed and the remaining tendon is repaired with sutures.
- 2. Debridement and tendon transfer – this surgery is used when there is greater than 50% damage to the tendon. Essentially, an Achilles tendon transfer is performed whereby a tendon from the big toe is moved to the heel bone.
- 3. Gastrocnemius recession – a surgical lengthening of the calf muscles.