What is Achilles Tendonitis?
Tendonitis by definition means inflammation of the tendon. Achilles tendonitis is the name we give to painful symptoms of the Achilles tendon. This can affect the back of the heel or just higher up from this.
What are the causes of achilles tendonitis?
The tendon inserts into the back of the heel and is connected with the calf muscle. Overuse and tightness of this tendon can develop symptoms. Discomfort is typically worse in the morning and can subside with mild activities.
Following more high impact activities such as running, the associated pain can reside as a mild ache at the back of the leg or behind the heel.
Investigation for achilles tendonitis
Examination of the tendon may be enough to confirm diagnosis, but in some cases, imaging can be helpful. Typically an ultrasound or MRI would be suggested.
Treatment for achilles tendonitis
Calf stretches are usually advised, you can speak with a physiotherapist or podiatric specialist for advice on the type and frequency of exercises to carry out. Stretching/ physiotherapy exercises may be suggested in combination with one/ all of the below.
Orthotics (insoles) can help control the mechanics of the foot and can include a small heel raise to reduce tightness.
A course of shockwave therapy may be suggested, where low level sound waves increase blood flow to the region and promote healing. Typically a course of three sessions is recommended.
Ultrasound guided steroid injections may be advised in some cases, there can be a risk of rupture to the tendon so typically an air cast boot will be provided to mobilise in for 1-2 weeks.
As a last resort, surgery may be suggested. This can include:
- gastrocnemius recession – reducing the excessive tension/ shortening of the muscle at the back of the leg, that is associated with destructive effects of the foot. This procedure is typically carried out in combination with additional surgeries.
- Debridement – where diseased or damaged tissue is removed from the achilles tendon, with the aim to allow new healthy tissue in its place.
Frequently asked questions
You should start by following RICE – rest, ice, compression and elevation.
If symptoms persist then visit your podiatrist, clinical treatments include shockwave therapy, orthotic therapy and in some cases a therapeutic injection. Regular stretches can also help.
Whilst sitting in a chair, extend your leg out and you should feel a stretch at the back of your leg. If you then reach out and hold your toes and pull them back towards you. Try holding this position for 20 seconds and repeat 3 times, twice a day.
This will vary depending on how severe the tendonitis is. Once your symptoms have mostly settled and you can walk without symptoms worsening, you should be ready to start running again, very gradually, waiting a few days between sessions.
Tendonitis means inflammation of the tendon. This will become inflamed if you have increased your activities too quickly. Running and jumping exercises put the most load through this tendon.