Achilles tendonitis
If you have ever had pain and swelling in your heel following a particularly strenuous run, this could be Achilles tendonitis. It is a really common condition amongst runners, particularly those who have taken up the hobby for the first time.
When the Achilles tendon becomes inflamed, we call it Achilles tendonitis. This can also sometimes be called Achilles tendinopathy. This condition is very common in the population, particularly amongst athletes.1 Although it can present differently in different people, the main symptoms are classically heel pain and swelling. It is the most common Achilles tendon injury.
The Achilles tendon – an overview
The Achilles tendon is found at the back of the foot in the heel. It is a tough band of tissue which connects the bones in the foot to the calf muscles. It helps move the foot when the calf muscles contract. This helps you walk, run and jump. It is able to do this job very well as it is the thickest and longest tendon in the human body, measuring around 6 cm in total.2
The Achilles Tendon is named after a warrior in Greek mythology, Achilles, who was killed in battle by a poisoned arrow to his heel. The myth states he was dipped into magical water by his mother making his whole body totally invulnerable apart from one part – his Achilles tendon.3
Causes of Achilles tendonitis
Achilles tendonitis is typically caused by overuse of the tendon. This mostly occurs in runners but also occurs in other athletes and walkers. The tendon can become stretched and strained during intense usage which can stimulate immune cells to move to the area in an attempt to repair it.
It can also be part of a pre-existing problem like an inflammatory arthritis. This will typically cause swelling and pain in both tendons.
Pre-existing problems with feet can predispose people to Achilles tendonitis. Flat feet and hyperpronated feet (inward-turning feet) make the condition far more likely. This is because the flattened arch of the feet puts the tendon under more constant stress.
Some antibiotics can cause Achilles tendonitis. This group of antibiotics are called fluoroquinolones and often treat chest and urine infections. Examples of these drugs are ciprofloxacin and levofloxacin.
Risk Factors for developing Achilles tendonitis:6,7
- Pro athletes – particularly runners
- Middle age
- Male sex
- Obesity
- Lack of regular exercise
- Inflammatory conditions e.g. rheumatoid arthritis
- Diabetes
- Smoking
- Certain medications – such as ciprofloxacin, levofloxacin and steroids.
- Unsupportive footwear e.g. sandals, flat shoes
Symptoms of Achilles tendonitis
Signs and symptoms of Achilles tendonitis:4,5
- Pain and swelling over the tendon and heel – this pain often comes on gradually. It will limit strenuous activities such as running. However, you will still be able to continue with normal day-to-day activities such as walking
- Stiffness of the ankle joint – you will not be able to move your ankle joint as freely as before.
- Tenderness over the heel – pressing on the back of the heel will cause pain.
- Symptoms typically lasting less than 2 weeks
FAQs
How long does it take to recover from Achilles tendonitis?
This can vary from person to person. Achilles tendonitis usually resolves itself within 2 weeks. However, if your symptoms last more than 6 weeks you may have developed chronic tendonitis.
How common is Achilles tendonitis?
It is estimated 150,000 people in the UK are diagnosed with the condition every year.8
Are there any serious complications of Achilles tendonitis?
Some cases of Achilles tendonitis can lead to rupture (complete tear) of the tendon. However, the evidence of this is limited.
Can I keep running with Achilles tendonitis?
Running and associated overuse injury is a common cause of tendonitis. You should probably take some days off running if you have developed tendonitis to give your tendon sufficient time to recover.
Summary
Achilles tendonitis is inflammation of the large tendon in the heel connecting your calf muscles to the bones in your feet. This is commonly caused by overuse of the tendon – typically in runners and other pro athletes. These individuals are often exerting their joints more than usual, especially if they are new to running.
Achilles tendonitis should be suspected if you have increased pain during exercise, swelling over the ankle joint and tenderness over your heel.
If you have injured your ankle or heel and are no longer able to put any weight on your foot, you should seek medical attention from a health professional.
References
- Paavola M, Kannus P, Järvinen TA, Khan K, Józsa L, Järvinen M. Achilles tendinopathy. JBJS. 2002 Nov 1;84(11):2062-76.
- Doral MN, Alam M, Bozkurt M, Turhan E, Atay OA, Dönmez G, Maffulli N. Functional anatomy of the Achilles tendon. Knee Surgery, Sports Traumatology, Arthroscopy. 2010 May;18:638-43.
- Taylor RB. The amazing language of medicine. Springer International Publishing AG; 2017.
- Weinfeld SB. Achilles tendon disorders. The Medical Clinics of North America. 2014 Mar 1;98(2):331-8.
- Järvinen TA, Kannus P, Paavola M, Järvinen TL, Józsa L, Järvinen M. Achilles tendon injuries. Current opinion in rheumatology. 2001 Mar 1;13(2):150-5.
- Rogers BS, Leach RE. Achilles tendinitis. Foot and Ankle Clinics. 1996 Dec 1;1(2):249-59.
- Maffulli N, Longo UG, Kadakia A, Spiezia F. Achilles tendinopathy. Foot and Ankle Surgery. 2020 Apr 1;26(3):240-9.
- Kearney RS, Parsons N, Costa ML. Achilles tendinopathy management: a pilot randomised controlled trial comparing platelet-rich plasma injection with an eccentric loading programme. Bone & joint research. 2013 Oct 1;2(10):227-32.
