What Is Achilles Tendinitis?

Overview 

To help the flow of this article, we must first understand what the Achilles tendon is before talking about Achilles tendinitis. So what is Achilles tendon? Well, the heel bone and the calf muscles are connected by a strong band or tendon that runs down the back of each of your legs. In the human body, it is the largest and strongest tendon.¹

Your Achilles tendon makes it possible for you to stand on your toes, walk, jump, and run. A human has one Achilles tendon on each foot. The Achilles tendon tends to become inflamed and may result in Achilles tendinosis, Achilles tendinitis, bursitis, or even an acute Achilles tendon rupture under excessive pressure or strain.²

The Achilles tendon is a stringy structure that can withstand pressure from jumping, running, and walking. However, if overused, it can become inflamed and irritated, which can cause Achilles tendinitis and make running, walking, and jumping painful. Young adults who play competitive sports, such as tennis, dancing, football, running, and basketball frequently get Achilles tendonitis.³

If you have Achilles tendinitis, keep in mind that it can be managed and treated. This article will look at the possible causes, symptoms, management, and potential treatments of Achilles tendinitis. Also, in this article, we will be using the word "tendonitis" and "tendinitis" interchangeably because they are both variant words, they mean the same thing.

Causes of Achilles tendinitis 

Your Achilles tendon may become strained if you apply too much pressure to it. When a tendon is overused, it can become inflamed and cause pain. Tendinitis can affect anyone who exercises regularly or abruptly intensifies their training regimen. The Achilles tendon is at risk for the following conditions:

• Use of certain antibiotics⁴
• Age⁵
• Medical condition 
• Sex⁶ 
• Standing, running, or jumping for a long period.
• A sudden increase in physical activity.
• Wearing unsupportive shoes.⁷
• Exercising on a hard or uneven surface.
• Smoking⁸ 
• Metabolism disorder 
• Obesity⁹
• Type 2 diabetes¹⁰

Signs and symptoms of achilles tendinitis 

You might have a slight soreness above your heel or at the back of your leg following any athletic exercise. Continually engaging in sports without resting could make it worse. Below are relatable Achilles tendonitis symptoms you should look out for: 

• The thickness of the Achilles tendon
• Swelling around the back of your heel
• Severe pain at the back of your heel after physical activity
• Pain and stiffness of tendon in the morning
• Pain at the back of your heel when you wear shoes or after removing your shoe
• Difficulty standing on your toes
• Pain when you flex your feet downwards, upwards, or sideways
• Pain after climbing the hill or stairs.

Management and treatment for achilles tendinitis 

Achilles tendonitis management and treatment must be done carefully to prevent worsening pain, injury, or swelling. However, there are several ways to manage tendinitis, treat it, and prevent it from getting worse. The methods include the following:

• Non-surgical treatment 

This method involves the R.I.C.E method which will be explained below:

1. Rest: Make sure to stay away from any activity or exercises that put too much pressure on your tendon and cause pain for a few days. You can try other less intensive activities like swimming

2. Ice: After working out or whenever you begin to feel tendon pain, apply an ice pack to the affected tendon. You can place the ice pack there for 20 minutes every 2-3 hours or as many times as needed

3. Compression: Use a soft brace or compressive surgical tape. Wrap it around the area to prevent swelling and relieve pressure on your tendon

4. Elevation: When you go to bed at night, elevate the affected leg on a platform, preferably a pillow. You can rest your leg on the pillow, but make sure it's elevated or raised above your heart. This is advised to reduce swelling

• Physical therapy treatment 

Your therapist may suggest the following treatment options:

1. Exercise: Your therapist might suggest calf stretches and massages as exercises to help relax and strengthen your calf and tendon. Please be aware that this treatment can be carried out at home 

2. Orthotic braces: This is a wedge that you wear and place into your shoe to relieve pressure on your tendon and support it, lowering your risk of swelling or excruciating pain

• Shockwave therapy 

This is the use of electromagnetic pulses or compressed air to deliver shock waves¹¹ to the injured tendon, which aids in pain relief and tendon healing.

• Medication 

To temporarily reduce pain, non-steroidal anti-inflammatory medicines (NSAIDS), such as ibuprofen, can be used.¹² Note that you should always speak with a medical expert before using any medication.

For tendinitis pain relief, you can receive steroid injections directly into the damaged tendon. Please be aware that frequent injections of this steroid into your tendon could weaken it and cause an Achilles rupture. 

• Surgery 

Surgery may be the best option if various forms of treatment and non-surgical methods have been tried for six months with no apparent improvement. Surgery is also advised when there is an Achilles rupture. An acute Achilles tendon rupture can be a partial or complete tear of your tendon.

FAQs

How is Achilles tendinitis diagnosed? 

Only a physical examination can determine if you have Achilles tendonitis. Your healthcare provider will ask you detailed questions before performing any examinations to find out the nature, extent, timing, and causes of your pain as well as what physical activities made it worse for you.

After gathering the required data, a physical examination will be done to determine the severity of the tendinitis. The physical examinations include:

• Ultrasound
• X-ray 
• MRI 

The orthopaedic surgeon may also evaluate you physically by doing the calf squeeze also known as the Thompson calf squeeze test.¹³ You will need to lay face down on the bed with your legs dangling off the examination couch or bed while undergoing tests. First, the surgeon applies pressure to your calf to determine whether your Achilles tendon is still intact or detached. 

How can I prevent achilles tendinitis? 

You can prevent Achilles tendinitis by adopting the following tips:

• To prevent overusing or stressing your Achilles tendon, try a range of workouts
• Include some brief stretching and warming up in your routine before engaging in any physical activity, to put your Achilles tendon on high alert and warmed up for any activity afterward
• Stop exercising or any physical activity if you experience pain. You can rest a bit and continue later. Please stop the workout or activity completely if the pain continues after a break
• Wear supportive or protective shoes
• Slowly increase the intensity of exercise or physical activity so as not to put a strain on your Achilles tendon
• Avoid hills, uneven surfaces, or the constant use of long stairs

Don't hesitate to see your healthcare provider if, despite taking all these precautions, your Achilles tendon continues to hurt.

Who  is at risk of Achilles tendinitis? 

People who are at risk of Achilles tendinitis include:

• People who are into sports that require fast stop-and-start, examples of sports include soccer, basketball, running, volleyball, etc
• Those who only participate in sports or physical activity just on weekends. This is because their bodies are not accustomed to stress, which may result in Achilles tendon strain
• People do train on hard or uneven surfaces
• Age also plays a part in this because as you age, your tendon loses flexibility and makes you more susceptible to Achilles tendinitis
• Use of certain drugs like antibiotics, aromatase, and high doses of corticosteroids^{14 15 16}

How common is Achilles tendinitis?

Athletes, active persons, or people who only participate in physical activity on the weekends frequently experience Achilles tendonitis. Around 150,000 people in the UK are affected annually, according to the NHS.¹⁷ Men are more likely than women to be affected.

When should I see a doctor? 

It's a good idea to keep an eye out for any changes, and you should consult a doctor if any of the following take place:

• You can visit your health care professional after trying the non-surgical method (R.I.C.E) for a few weeks and Achilles tendon pain persists
• If you notice redness or swelling in the affected area
• If you have lost control of your foot, that is when you can't flex your foot downwards, upwards, or sideways
• If you notice or experience a partial or complete Achilles tendon rupture

How long will recovery from Achilles tendinitis take?

Recovery takes about a few weeks or a few months depending on the severity of the tendon injury.

Summary 

Achilles tendonitis is an inflammation of the Achilles tendon that hurts and is uncomfortable. Because they develop around the heel, some individuals occasionally confuse it with plantar fasciitis. Achilles tendonitis affects the back of the heel, but plantar fasciitis produces severe pain under the heel.

Certain exercises, posture, smoking, obesity, and physical activities, among others, can all contribute to Achilles tendinitis. Swelling and persistent discomfort in the back of the heel are common symptoms of Achilles tendinitis.

Fortunately, there are remedies for Achilles tendon pain and injury. You can try surgery, physical rehabilitation, or a non-surgical approach. Your orthopaedic surgeon will only recommend surgery if you have torn a tendon or if the pain doesn't go away despite trying non-surgical options and physical therapy. 

Make sure to see a doctor if you have severe pain at the back of your heel, lost the ability to flex your foot, or experienced swelling behind your heel.