The Achilles tendon, largest in the body, gets its name from Greek mythology. According to one legend, Achilles was a baby when his mother attempted to make him immortal by dipping him in the river Styx (the boundary beween Earth and the underworld). The only part of the infant that was left uncoated by the water was the back of the foot where his mother grasped him with one hand.
Today, the Achilles tendon has a more contemporary meaning. It is an often-injured part of the ankle that can be irritated or even ruptured with trauma (Achilles tendon rupture) (as in sports injuries) or arthritis.
When we refer to Achilles tendinitis, we may mean noninsertional or insertional tendinitis. Noninsertional tendinitis, which is when fibers in the middle of the tendon develop tiny tears, swell and thicken, usually affects active people who participate in sports. Noninsertional tendinitis involves the lower part of the heel where the tendon attaches, or inserts, to the heel bone. Bone spurs often form in the wake of insertional Achilles tendinitis, which can afflict anyone— not just athletes.
In either case, damaged tendon fibers may calcify, or harden. Achilles tendinitis is usually a result of repetitive stress, when we are pushing our bodies beyond their limits.
We see many cases of Achilles tendinitis in our clinics in Dallas, DeSoto and Sunnyvale, and they are caused by a variety of factors.
How Do You Know If It’s Your Achilles?
The symptoms of Achilles tendinitis may come on gradually, or the patient may feel a sudden popping sensation in the back of the heel.
Other symptoms include the following:
- pain when you first stand up in the morning
- pain in the back of the heel that gets worse when you are active
- swelling in the back of the heel that gets worse with activity
- severe pain the day after you exercise
- palpable thickening of the tendon
- bone spurs, which can rub against the tendon and cause pain
The doctor can confirm the diagnosis with a physical examination. He or she will also look for certain signs such as swelling, enlargement of the tendon, the point of maximum tenderness, and restricted range of motion.
The doctor may also order imaging tests such as x-rays and/or MRI to document the extent and nature of the injury. Although MRI isn’t necessary to diagnose Achilles tendinitis, it is important if you are considering surgery because it reveals a detailed image of the damage to the tendon.
What is the Treatment for Achilles Tendinitis?
Most cases of Achilles tendinitis are resolved without surgery. It may take a few months, though, for the symptoms to completely disappear. If you had pain for weeks or months before seeking medical help, it may take longer for the treatment to take effect.
The first step in treating Achilles tendinitis is to stop or decrease the activity that initially caused the damage, or activities that exacerbate the symptoms. This may be difficult for motivated individuals. We recommend athletes and physical fitness enthusiasts investigate cross-training. Substituting low-impact exercises such as swimming, bicycling or elliptical training for running, tennis or basketball can help retain the patient’s fitness while allowing the Achilles tendon to heal.
Ice can be used to reduce swelling, and we recommend the application of an ice pack as often as needed during the day.
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen help reduce pain and swelling— although they will not lessen the thickening that takes place in the tendon.
Exercises to strengthen the calf muscles and relieve pressure on the Achilles tendon are also recommended.
While physical therapy and calf stretches are part of the rehabilitation process, these should be done under the supervision of an experienced doctor or physical therapist. Certain eccentric (muscle contraction) exercises can actually cause more damage to the Achilles tendon if they are not performed properly.