Achilles Tendinitis

What is Achilles Tendinitis?

The Achilles tendon is the largest tendon in the human body and also the most powerful.  Achilles tendinitis is a condition that results in pain and swelling to the back of the ankle.  The symptoms generally increase during physical activity and is usually a result of an overuse injury.  Any repetitive strain on the Achilles tendon can create this condition. achilles tendinitisAchilles tendinitis can lead to a tear or rupture of the tendon if left untreated.

Signs and Symptoms of Achilles Tendinitis

Initially the pain may present itself as a mild ache above the heel bone. The pain can become worse with activities such as running and jumping.  The pain can become severe with prolonged physical activities.  After periods of rest there may be stiffness to the ankle joint especially first thing in the morning.

Who gets Achilles tendinitis?

Anyone can suffer from Achilles tendinitis but it typically affects middle aged people who engage in activities involving running.  Children may also develop symptoms of Achilles tendinitis but their symptoms are typically less severe.  Men ages 30-50 are at high risk of rupturing their Achilles tendon.  People with flat feet cause more strain to their achilles tendon thus resulting in a higher prevalence of tendinitis.  Bad or improper shoe gear can lead to increased strain on the tendon thereby leading to tendinitis.  People who are obese, have high blood pressure, or are diabetic all have increased chance of developing tendinitis. Also, certain drugs such as fluoroquinolones (Cipro, Levaquin, Avelox) have been documented to cause Achilles tendinitis and spontaneous rupture of the tendon.

How is Achilles tendinitis diagnosed?

The doctor will diagnose Achilles tendinitis through a physical exam in combination with imaging studies (MRI/Ultrasound).  The patient’s reported history helps to formulate the diagnosis and advanced imaging such as ultrasound or magnetic resonance imaging (MRI) will confirm the diagnosis of Achilles tendinitis.

Conservative Treatments for Achilles Tendinitis

A heel lift which is a supportive insert you place under your heel in your shoes is used to help decrease tension off of the Achilles tendon.  This is one of the most basic treatments used for mild Achilles tendinitis.  Custom orthotic devices are used to decrease strain on the Achilles tendon by helping to maintain proper arch height.  Resting, icing, compression, and elevation to the affected foot can help tremendously.  Physical therapy exercises such as strengthening and stretching can help to reduce tension on the tendon. Anti-inflammatories can also help with symptoms.  If the pain is severe, a boot may be used to help limit motion to the ankle.  Crutches or some other non-weight bearing device could also be used to help with symptoms.

Should I inject cortisone into my Achilles’ tendon?

In short the answer is no.  Studies have shown that injection of a corticosteroid into the achilles tendon may cause damage to the tendon resulting in a spontaneous rupture.  Instead injections of platelet rich plasma or stem cells are very good alternatives.  Studies show that platelet rich plasma (PRP) show very good results in helping to heal achilles tendinitis.  Stem cell therapy is also a viable option and is typically used if PRP therapy fails.

Surgical treatment of Achilles Tendinitis

Surgical treatment is only considered after all conservative therapies fail or a rupture occurs.  Open repair of the achilles tendon is an option if a rupture is diagnosed and is deemed repairable. A MRI can help to confirm the extent of damage to the Achilles tendon.  Any surgical treatment of the Achilles will require a lengthy recovery period due to the high possibility of re-rupture.

Alternatives to Surgical Treatment of the Achilles Tendon

Extra corporeal shockwave therapy or ESWT for short, is a technology that utilizes pulses of energy to create a shockwave of force through the skin targeting damaged areas of the body.  When the shockwaves hit the damaged tissue it initiates a cascade of healing processes that are natural to the body.  This results in rapid healing to damage tissues such as the Achilles tendon.

Super pulsed laser therapy is another modality which can be used as an alternative to surgery.  The laser causes a natural increase in the body’s metabolism, oxygen capacity, decreases inflammation, and swelling to the injured area.  This treatment method works really well for Achilles tendinitis and also for partial tears of the tendon.

How do I prevent Achilles Tendonitis?

Wear appropriate shoe gear.  Invest in a pair of custom orthotics to help support the arch of the foot.  Decrease activities that cause pain to the achilles tendon.  Stretch regularly to help decrease tension to the tendon.  Wear a supportive ankle brace during prolonged activity to help offload the tendon.