Achilles Tendinitis

1 What is Achilles Tendinitis?

Achilles tendinitis refers to painful inflammation of the Achilles tendon, the largest tendon in the body that connects calf muscles with the heel.

The tendon is capable of withstanding increased stress. But at times, continuous and intense physical activity may increase the chance of injury and inflammation.

It is common in runners who suddenly increase their duration and intensity of running. It may also affect people, particularly middle-aged or older adults, who take up physical activity like tennis or basketball.

Simple home remedies are the best treatment options for Achilles tendinitis. With continuous activity, the condition may worsen, leading to a tear in the tendon.

Oral and topical medications, and surgery are usually the best treatment options, depending on the extent of damage. If left untreated, the condition may lead to Achilles rupture.

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2 Symptoms

Pain and stiffness in the back of the heel during an activity, particularly in the morning, is one of the most common symptoms of Achilles Tendinitis.

This pain may increase with activity, though initially the person may feel comfortable while doing the activity.

Prolonged running or activity results in severe pain. Pain increases a day after the exercise.

In some cases, tendon may show thickening at the region where it joins the heel bone. Flexing of foot and pointing of toes become difficult with an injury in the tendon.

The skin over the affected region will also be slightly warm to touch.

3 Causes

The main cause of Achilles tendinitis is repetitive stress to the tendon. This happens when one overexerts themself, leading to injury.

Achilles tendon may also be caused by sudden increase in the intensity of an activity like running or jumping. Thus runners who suddenly increase the distance before the muscles and tendons can adjust to it, end up with pain and stiffness in the tendons.

Starting or continuing a new exercise regimen when one has a stiff calf muscle can strain the tendon, resulting in inflammation.

Pain may also be caused by the growth of an extra bone, called a bone spur, which rub against the tendon at the back of the heel.

Achilles tendon weakens with age, and hence tendinitis is common in middle aged and older adults.

4 Making a Diagnosis

Making a diagnosis of Achilles Tendinitis is done by Physical examination. A doctor often checks the motion and flexibility of the leg while the patient stands on the balls of their heel.

Pain and swelling are generally intense at the area of damage, and palpation helps to identify the area of damage.

Extent of damage is assessed using imaging techniques like MRI, X-ray, and Ultrasound.

Imaging techniques

X-rays are used to differentiate pain caused by conditions other than Achilles tendon. It is useful in determining hardening of tissues in the tendon.

Ultrasound images are useful in visualizing the tendon tissue, the extent of damage, and the blood flow to the region.

MRI may not be needed in all cases of Achilles tendon, and is often suggested as a decision making tool for surgical repair. The image shows the severity of tendon damage.

5 Treatment

Symptoms of Achilles tendon may remain for about 3 months, even when the treatment has started early.

For those who seek treatment after few months of injury, the symptoms may last longer. About 5-6 months of treatment may be needed for the symptoms to subside.

RICE refers to a simple home remedy for relieving symptoms of Achilles tendon. This includes:

  • R - Resting the affected leg and avoiding putting weight on the leg
  • I - Applying ice pads at the affected region for 20-30 minutes for two to three days
  • C - Compressing the lower parts of the leg using an elastic bandage to reduce swelling 
  • E - Raising or elevating the leg while resting

Alternative treatments

Over the counter pain killers are effective in relieving swelling and pain in the affected region.

Strengthening exercises are effective in relieving the symptoms and in strengthening the tendon. Orthotic devices help to keep the heel raised and to provide a cushioning effect as well as preventing excessive strain on the tendon.

Surgery is recommended when the conservative treatment options are not effective.

Recovery time for a surgical repair depends on the extent of tendon damage.

6 Prevention

Strengthening calf muscles is one example of how to prevent Achilles Tendinitis.

Warm up and cool down exercises are important to prevent swelling and pain. Increase the duration and intensity of an exercise gradually.

Avoid over straining by combining exercises that have high and low impact on the heels.

Using appropriate sports gear and supportive shoes also help to prevent injury.

7 Alternative and Homeopathic Remedies

One example of an alternative and homeopathic remedy used for sport injuries, including Achilles tendinitis is Arnica.

Ruta helps to reduce pains, while Cimicifugia helps to relieve stiffness in the tendon. The treatment is continued for three to four weeks until the symptoms start to reduce.

Home remedies are the best alternative treatment strategy for tendon injury. This includes self-care measures like RICE.

8 Lifestyle and Coping

There are different ways to adapt your lifestyle in coping with Achilles tendinitis.

It is important not to return to the same level of physical activity until one can move their leg freely without any symptoms.

Give time for the leg to feel as strong as it was before the inflammation.

One should make sure that there is no pain while walking or jogging.

9 Risks and Complications

There are several common factors that increase the risk and affect complications of Achilles Tendinitis.

It is more commonly seen among men, and the risk increases with age.

Flat feet, tight calf muscles and obesity also increase the chances of tendon injury.

Running with inappropriate running gear can predispose to Achilles tendon.

Certain medications and medical conditions also increase the risk of tendon injury. If left untreated, it can result in tendon rupture.