What is the Achilles Tendon?
The Achilles tendon is one of the strongest tendons in our body. It starts near the knee and extends all the way down the back of your leg. It attaches into the back of your heel bone. Every step you take involves your Achilles Tendon. Every move your legs make involves your Achilles tendon. That’s why when it becomes inflamed, it hurts with every step you take. That is called Achilles tendonitis.
What are the 3 Types of Achilles Tendon Problems?
Achilles Tendonitis
Achilles Tendonitis occurs when the Achilles tendon is inflamed. The inflammation is usually in the lower third of the tendon as it attaches to the heel bone. You’ll often feel pain when you first step out of bed in the morning. The pain may reduce at that point. But, as the inflammation becomes worse, the pain can continue with each step.
Achilles Tendonosis
Achilles Tendonosis is also an inflammatory condition of the Achilles tendon. With Achilles Tendonosis, there is degeneration of the tendon. This leads to microtears throughout the substance of the tendon. Often, a swelling of the tendon can occur with Achilles Tendonosis. The pain also becomes pretty constant.
Achilles Tendon Rupture
Persistent degeneration of the Achilles tendon can lead to an Achilles tendon rupture. It can also be caused by trauma. A partial rupture needs to be addressed with immobilization to allow the tendon to heal. A complete rupture will need surgery to reattach the tendon. It is essential for an Achilles tendon rupture to be identified and treated as soon as possible.
Causes of Achilles Tendonitis
Achilles tendonitis is a common overuse injury. That means that repetitive stress on the tendon causes it to be overworked. This leads to inflammation. Since the tendon is the largest and strongest in your body, it is involved in every step you take. That’s true whether you’re running, walking, or jumping.
Some common causes of Achilles tendonitis include:
- Exercising without warming up or stretching first
- Straining of the calf muscle during exercise
- Increasing your speed, mileage, or intensity too fast while training
- Sports that require starting, stopping, pivoting, and lateral movements. These include tennis and basketball.
- If your legs aren’t the same length, it’ll cause extra stress on the Achilles tendon
- People with flat feet, which causes more strain on the Achilles tendon
- Go figure…people with high-arched feet also strain the Achilles tendon
- Wearing shoes that are old, have lost their support, and need to be replaced
- Wearing high heels. This causes shortening of the Achilles tendon
Symptoms of Achilles Tendonitis
Pain within the Achilles Tendon
There can be pain along the course of the Achilles tendon. There are two common areas that become inflamed and painful. The first is at the attachment of the Achilles tendon at the back of the heel bone. The other is above that in the tendon itself. These areas of the tendon don’t have a good blood supply and are more prone to inflammation.
It’s common to experience pain with the first steps out of bed in the morning. The pain diminishes as you start to walk. As the condition worsens, the pain may be felt throughout the day. The pain in the Achilles tendon is often felt with increased activity. This includes walking distances, running, exercise, and participating in sports.
Tenderness with Lateral Pressure on the Achilles Tendon
The inflammation causes an increased sensation of pain when the tendon is squeezed. When there is pressure directly on the tendon, the pain is not as bad.
Swelling of the Achilles Tendon
It is common to see a swelling of the tendon when there is degeneration of the fibers of the Achilles tendon. This shows up as a fusiform (cigar-shaped) swelling on the back of the leg with pain noted on compression. You also may feel a warmth to the touch. It is also common to notice a decreased range of motion.
Extreme Pain in the Back of the Calf
If the Achilles tendon ruptures, you will experience severe pain when it happens. Most people describe the sensation as being kicked in the back of the leg. It is difficult to bear weight on the leg after an Achilles tendon rupture. Any severe pain like this should bring you to our office for an emergency visit. After hours, you should go to the hospital emergency department.
Diagnosing Achilles Tendonitis
In my office, I need to be able to determine the cause of your Achilles tendon pain. I do this with a detailed lower extremity examination. I may also use other modalities, such as:
- X-ray
The Achilles tendon does not show in great detail on x-ray. Even so, it is important to make sure there are no stress fractures in the area. Injuries such as a stress fracture can mimic the pain from Achilles tendonitis.
- Diagnostic Ultrasound
Ultrasound allows me to image the Achilles tendon and be able to find areas of inflammation. It is also possible to find an Achilles tendon tear by using ultrasound. It is a quick, simple, and painless in-office test which provides great information.
- MRI
In cases where an Achilles tendon rupture is suspected, an MRI will be ordered. I’ll also order an MRI in cases where the Achilles tendon pain does not resolve with time. An MRI is much more specific than the ultrasound. I’ll be able to see all aspects of the Achilles tendon in great detail.
Treatment of Achilles Tendonitis
Reducing Your Physical Activity
I hate telling people that they have to stop doing the activities they love to do. But in the case of Achilles tendon pain, it is necessary. Once the pain has reduced and the condition is under control, you’ll be able to get back to the activities and exercise you love.
Oral Anti-Inflammatory Medication
Inflammation of the tendon causes the pain associated with Achilles tendonitis. As such, taking a course of anti-inflammatory medication will reduce the inflammation. This will, in turn, reduce the pain.
Night Splint
When you sleep, your position of comfort is to point your toes. This shortens your Achilles tendon. Using a night splint keeps a mild stretch on the Achilles tendon overnight. This will minimize the pain that you feel with your first steps in the morning. It will stop the tendon from becoming inflamed right away.
Custom Orthotics
Having a flat foot or high-arched foot can contribute to the tension on the Achilles tendon. This can lead to the overuse that causes Achilles tendonitis. A custom orthotic will support the foot mechanics. This will reduce the pull of the Achilles tendon. A custom orthotic is an excellent long-term treatment. It is used to prevent Achilles tendonitis from reoccurring.
Regenerative Medicine
Treatments using regenerative medicine are becoming more available and affordable. This includes Platelet Rich Plasma (PRP), Amniotic Stem Cells, and Exosome Cells. These injections serve to reduce the inflammation associated with Achilles tendonitis. They also work to regenerate the damaged tissue. Often, we see a faster recovery with the use of regenerative medicine.
Important Note: A corticosteroid injection should never be used around the Achilles tendon. It can weaken the tendon and cause an Achilles tendon rupture. Only regenerative injectables should be used around the Achilles tendon.
Physical Therapy
Physical therapy is an excellent addition to your therapy for Achilles tendonitis. A physical therapist will work with modalities to reduce the inflammation. The therapist will also help with building up strength and function.
Tenex Ultrasonic Tissue Repair
When nothing else eliminates your Achilles tendon pain, there is a solution. Tenex is a procedure that uses a radiofrequency probe inserted into the inflamed section of the tendon. The waves break up the inflamed tissue and the system removes it from the area. It is a short, minimally invasive procedure. It is, however, done in the operating room under anesthesia.
Surgery to Repair the Achilles Tendon
If you’ve experienced a complete rupture of the Achilles tendon, it will require surgery to repair it. If this is the case, we will discuss the procedure in detail in the office.
What Doctor Should You See for Achilles Tendonitis Pain?
If you have persistent pain from Achilles tendonitis, you need to come in to get it checked. Houston podiatrist Dr. Andrew Schneider will be able to diagnose your condition. We will work together to discuss what is the best treatment option for you. Contact our office to schedule an immediate appointment.
