FOOT & ANKLE

Achilles Tendinitis

The Achilles tendon is one of the longer tendons in your body which stretches from the heel bone to your calf muscles. It appears as a band of tissue at the back of your ankle and above your heel. The Achilles tendon attaches to the heel bone over a broad area. Achilles tendinitis is a common condition where the tendon becomes irritated and inflamed due to overuse.

There are two types of Achilles tendinitis.


  • Non-insertional (Left): Where pain can occur within the tendon itself leading to swelling and thickening in the middle portion of the tendon. This is more common in younger, active people, especially runners.


  • Insertional (Right): At the point where it attaches to the heel bone. This can occur at any time or activity level, although commonly occurs in people between ages 40-50 years. The conditions associated with increased risk are spondyloarthropathy, gout, psoriasis and Reiter’s syndrome, sarcoidosis, familial hyperlipidaemia and diffuse idiopathic skeletal hyperostosis. It can also be caused due to the use of medications such as steroids and certain antibiotics.

Symptoms

Common symptoms of Achilles tendinitis include:

  • 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 following exercise
  • 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



Causes

Achilles tendinitis is typically not related to a specific injury. The problem results from repetitive stress to the tendon which often happens when we push our bodies too much, too quickly. Calf muscle tightness can also put extra stress on the Achilles tendon, especially where it inserts into the heel bone. 


Treatment Options

Non Operative Treatment

In most cases Achilles tendinitis can be treated non operatively. To manage pain you will likely be prescribed pain killers (paracetomol or panadol osteo) and anti-inflammatories if tolerated and not contraindicated. You may be asked to wear heel lifts, night splints, arch supports and proper shoes. Physical therapy and stretching may also be suggested. In case these treatments fail, then your doctor may apply a cast or braces to facilitate healing.


Surgery

If non operative treatment has been ineffective, surgical intervention may be advised. During surgery, the degenerative portions of the tendon and any bone which is irritating the tendon will be removed. If the tendon is short, then lengthening may be done by using grafts. The tendon attachment to the heel bone will be strengthened with sutures. After surgery, your doctor might recommend wearing a splint for 2 weeks in a toe down position to allow complete healing.

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