Updated: Aug 13, 2018
The Achilles tendon is the strongest and largest tendon in the human body. It is the soft tissue structure that connects your calf muscles (gastrocnemius and soleus) to your heel bone and functions during the gait cycle to help you propel forward and lift your heel off the ground.
CAUSES OF ACHILLES TENDINITIS
Pain within the Achilles tendon (aka tendinitis) can result from several factors, including overuse, trauma, switching from high-heeled shoes to flatter shoes, and degeneration of the tendon (aka Achilles tendinosis).
Symptoms may include increased warmth, swelling, and/or pain. Pain is commonly felt along the back of the heel bone (known as insertional Achilles tendinitis) or within the tendon just before it inserts into the heel bone (known as noninsertional Achilles tendinitis). Pain is often more noticeable with certain activities (e.g. walking, running, going up hill or up an incline). If the tendon is ruptured, loss of function of the tendon will be found. If there is a bony prominence along the back of the heel (aka pump bump), one may also experience pain or irritation inside a shoe.
Rest, Modification of activities, & Immobilization – Avoid higher impact activities (e.g. walking, running, jumping) and switch to lower impact activities (e.g. swimming, biking) until symptoms improve or resolve. Any activities that you participate in that cause pain to the affected limb will only prolong, or inhibit, the healing process. Depending on the extent of the injury and the amount of pain you are experiencing, will determine how aggressive you need to be with resting and/or immobilizing of the extremity and how long it will take to return to regular activities. This may require wearing a walking boot or walking cast to allow the tendon to heal quicker.
Icing & anti-inflammatory medications – Icing one to two times daily (especially after exercise) can help decrease inflammation. (**Avoid icing if you have neuropathy/numbness or poor circulation). Anti-inflammatory medications can also help with inflammation, but should not be used chronically.
Steroid injections are not recommended in this area as they can cause weakness (and potential rupture) of the tendon.
Shoe gear – You should wear good, supportive tennis shoes or walking shoes (e.g. New Balance, Brooks, ASICS, Saucony) as much as possible and avoid barefoot walking and use of flat shoes and flip-flops. Wearing a shoe with a slight heel may also help because it takes tension off the tendon.
Orthotics – These are devices that go into your shoes to help cushion, support, and control abnormal motion(s) of your feet. They can also help with the alignment of the lower extremity more proximally, including your knees, hips, and back. They can be purchased off-the-shelf or be custom-made to fit your feet.
Heel lifts/cushions – Heel lifts work like heeled shoes and can be placed in your shoes to slightly elevate your heel, which, again, takes tension off the Achilles tendon. They should only be used temporarily, though, because over time, the Achilles tendon may accommodate to this shortened length, which will cause shortening of the tendon over time. Heel cushions can add extra padding or cushion along the bottom or the back of the heel.
Stretching – This is important because many people that develop tendinitis of the Achilles have tight calf muscles. This should be done after a period of rest, once the inflammation has improved or resolved. The stretching exercises can either be done on your own or under the guidance of a trained physical therapist.
Surgery – This is considered if the patient has failed conservative care for at least 6 months. Treatment options vary depending on several factors, including the type of tendinitis (insertional or noninsertional), the presence of calcified deposits within the tendon and/or a pump bump, and the tightness of the calf muscles. The recovery can range from weeks to several months. Your doctor can discuss the details further with you should you need surgical intervention.
DISCLAIMER: The above information is meant for educational purposes only and should not be construed as medical advice. Please contact the doctor, or your own healthcare professional, should you have questions or concerns related to your health.