Achilles Tendinitis

Achilles tendinitis is a very common injury of the Achilles tendon and is most often seen among athletic patients, particularly runners.

Achilles Tendon

The Achilles tendon connects the calf muscles to the heel and is the largest tendon in the body. It can take on a great deal of stress during many activities, like walking, running, climbing stairs, and jumping. As a result, the Achilles tendon is susceptible to inflammation. This inflammation is known as Achilles tendinitis.

Our orthopedic foot and ankle surgeons at OrthoMed Center have vast experience treating running injuries, such as Achilles tendinitis.

Causes of Achilles Tendinitis

Causes of
Achilles Tendinitis

Achilles tendinitis typically occurs due to:

Overuse or placing too much stress on the tendon
A sudden increase in the frequency or intensity of exercise and tight calf muscles
Bone spurs, excess bone growth where the Achilles tendon attaches to the heel

Symptoms of Achilles tendinitis

Symptoms of
Achilles tendinitis

Symptoms of Achilles tendinitis include:

Pain at the back of the heel along the Achilles tendon
Pain that gets worse with activity, particularly the day after exercising
Pain and stiffness in the morning along the Achilles tendon
Swelling around the tendon

You should seek immediate medical attention if you feel a “pop” at the back of your heel. This usually indicates a tear in the Achilles tendon.

Types of Achilles Tendinitis

Achilles tendinitis can be of three types:

Paratenonitis
Insertional Achilles tendinitis
Noninsertional Achilles tendinitis

Paratenonitis is an inflammation of the paratenon, the outer lining, or coating of the Achilles tendon. Paratenonitis causes painful adhesions between the Achilles tendon and the outer lining. This condition often occurs in runners.

Insertional Achilles Tendinitis involves the lower portion of the Achilles tendon at the point where it attaches to the heel. It typically occurs due to overuse, but certain anatomic deformities can increase the chance of developing insertional Achilles tendonitis. Therefore, people with a square-backed heel, Haglund’s deformity, or other bony protrusions like heel spurs have a higher risk of developing Achilles tendinitis because the bone rubs against the tendon.

Furthermore, insertional Achilles tendinitis can cause other complications, such as inflammation of the bursa (a small fluid-filled sac at the back of the heel that reduces friction between the bone and soft tissues) and traction injuries (tightness in the Achilles tendon), creating more bone spurs at the back of the heel.

Noninsertional Achilles Tendinitis generally occurs in the middle portion of the Achilles tendon, about 4-6 cm above where it attaches to the heel. This region is called the “watershed” of the Achilles tendon because it has a poor blood supply and does not heal as quickly as areas with greater blood supply.

Noninsertional Achilles tendinitis is also a degenerative condition in which the tendon fibers begin to fray and tear. Over time, the tendon starts to thicken, causing significant pain.

Treatments for Achilles Tendinitis

Treatments for
Achilles Tendinitis

Treatment options vary based on the type of Achilles tendinitis. When you come in for a consultation with one of our board-certified orthopedic specialists, they will perform a thorough examination and create a treatment plan suited for you. Achilles tendinitis can be treated using both nonsurgical and surgical treatment options.

Nonsurgical Treatment

Initial treatment for Achilles tendinitis is typically conservative. Topical or oral anti-inflammatory medications may be recommended to help reduce pain and swelling.

Nonsurgical treatment for paratenonitis includes:

Physical therapy
Rest
Braisement (Ultrasound-guided injection of sterile saline or Lidocaine between the Achilles tendon and the tendon sheath. Breaks up adhesions and is effective in relieving pain.)

Nonsurgical treatment for insertional Achilles tendinitis includes:

Physical therapy
Stretching
Rest
Ice
Compression
Elevation of the foot
High energy ultrasound
Amniotic allograft injection performed using ultrasound-guided needle delivery of medication (PRP, amniotic, and steroid)

Nonsurgical treatment for Noninsertional Achilles Tendinitis includes:

Physical therapy, particularly eccentric stretching. Eccentric stretching involves contracting or tightening the Achilles tendon as it lengthens.
Platelet-rich plasma (PRP) injections, which involve extracting plasma from the patient’s blood to create a concentrated plasma solution that is then injected into the injured area of the patient’s Achilles tendon. This boosts blood supply to this region and can promote healing.
Amniotic allograft injection performed using ultrasound-guided needle delivery of medication (PRP, amniotic, and steroid).

In cases where the Achilles tendon ruptures, it may be treated with a plantarflexion cast for approximately 8 weeks if it is detected very soon after the tear occurred and there is no gaping in the tendon. However, if the tear is not detected right away, or if there is a gap in the tendon, surgery is recommended.

Surgical Treatment

If nonsurgical treatment options are not successful, surgery may be recommended. Surgical treatment for Achilles tendinitis may involve debridement or removal of damaged tissue and heel spurs (if present). The tendon can then be repaired.

For insertional Achilles tendinitis, the tendon is detached from its insertion point at the heel, and the damaged tissue is removed. The tendon is then reattached and repaired.

If the Achilles tendon is torn, surgical repair may be necessary. The goal of treating a ruptured Achilles tendon is to have the tendon heal at the correct length. Our orthopedic foot and ankle surgeons often recommend minimally invasive techniques for Achilles tendon repair. Minimally invasive techniques require smaller incisions than traditional surgical repair (open procedures) done through a large open incision. Minimally invasive techniques also often have lower rates of complication as compared to open procedures.

Within 6 weeks of surgery, patients typically begin physical therapy, which is an important part of the recovery process. Patients begin with weight bearing exercises.

Preventing Achilles Tendinitis

You can prevent injuries to the Achilles tendon by increasing your exercise activity gradually so that your body can better adjust. It is also important to work on flexibility by stretching the calf muscles to avoid unnecessary stress to the Achilles tendon.