Posts for tag: Achilles Tendonitis
Heel pain is one of the most common complaints a podiatrist hears about from patients. If you are dealing with heel pain above the heel bone then you could be dealing with Achilles Tendonitis, a result of overuse. The Achilles tendon is the longest tendon in the body and it serves to connect the muscles of the calf with the lower leg and heel bone.
While Achilles Tendonitis tends to occur most often in runners, this condition can still occur in athletes that play certain sports such as soccer or tennis. Unfortunately, this tendon does weaken as we get older, which makes at an increased risk for developing this overuse injury as we age.
What are the symptoms of Achilles Tendonitis?
The most obvious symptom of Achilles Tendonitis is pain above the heel bone. When the pain first appears it’s usually pretty mild and you may only notice it after running; however, over time you may notice that the pain gets worse after certain exercises. Along with pain you may also experience stiffness or tenderness in the heel, especially in the morning or after long periods of sitting.
When should I see a podiatrist?
If this is the first time that you’ve ever experienced heel pain then it’s a good idea to turn to a foot doctor who can determine whether Achilles Tendonitis is causing your symptoms or whether it’s something else. If you’re experiencing chronic heel pain around the Achilles tendon it’s also a good time to see a doctor. If the pain is severe or you are unable to put weight on your foot it’s possible that you might be dealing with a ruptured tendon, which requires immediate attention.
How do you treat Achilles Tendonitis?
In most cases, Achilles Tendonitis can be treated with simple self-care options. Unless symptoms are severe you may be able to treat your heel pain by:
- Taking over-the-counter pain medications
- Avoiding high-impact activities or activities that exacerbate symptoms
- Elevating the foot to reduce swelling
- Performing stretching exercises or undergoing physical therapy
- Icing the heel
- Wearing custom orthotics
- Replacing worn-out shoes, especially running shoes
Surgery is only necessary if your symptoms aren’t responding to any other nonsurgical treatment options after several months or if the tendon is torn.
If you think your heel pain could be the result of Achilles Tendonitis then it’s time to turn to a podiatrist as soon as possible. A podiatrist can provide you with a variety of treatment options, from simple lifestyle modifications to custom orthotics.
What is it?
The Achilles tendon is the largest and strongest tendon in the body. It can support up to 12x your body weight! It is made up of two muscles: the Gastrocnemius and the Soleus. The Gastrocnemius muscle inserts above the knee and the Soleus muscle below the knee. Tightness in the Achilles tendon (called Equinus) can lead to pathology usually manifesting as pain in the tendon about 2-6cm above its insertion into the back of the heel (Non-insertional Achilles Tendonitis) or at the insertion itself (Insertional Achilles Tendonitis). Sudden increases in the intensity or amount of exercises can also lead to pain in the Achilles tendon.
Common symptoms of Achilles tendinitis include:
- Pain in the Achilles tendon with the first few steps in the morning
- Pain with increased activity
- Thickening of the tendon which you can feel approx. 2-6 cm above the insertion
- Bone spur on the back of the heel which you can sometimes feel if it is large
- Swelling and pain which worsen throughout the day
Diagnosing Achilles Tendonitis
The following are usually required for the physician to make an accurate diagnosis: a complete history of the complaint; a lower extremity physical exam including: assessing the Achilles range of motion (specifically a decrease in ankle joint dorsiflexion), palpation for signs of thickening of the Achilles and bone spurs, finding the point of maximum tenderness etc …
X-rays are helpful to assess for heel spurs and to rule out other causes of heel pain including stress fracture. Ultrasound examination can give the physician a dynamic view of the Achilles tendon. The thickness of the tendon, any possible tearing, or the existence of an inflamed bursa can be assessed with the ultrasound. MRI is also sometimes useful and can give a full picture of the tendon and the degenerative changes that may exist.
Treating Achilles Tendonitis
Treatment depends on severity. Most of my patients have already tried some kind of home therapy including anti-inflammatory medications, ice, rest, stretching etc… In some mild cases of Achilles tendonitis these treatments may be sufficient, but in many cases they are not. A physician may treat Achilles tendonitis with heel lifts, orthotics, adaptive shoe gear, a below knee cast or walker, NSAIDs, Medrol Dose Pak, Physical Therapy, etc… The average recovery time is 3-6 months.
If conservative care fails then surgical treatment may be an option. For insertional Achilles tendonitis this usually involves removal of the heel spur, debridement of the Achilles (removal of diseased portions), with or without lengthening of the Achilles (Gastrocnemius recession). To remove the heel spurs, the Achilles must be partially or completely released from its insertion into the calcaneus (heel bone). Following this release, strong anchors are placed in the bone to reattach the Achilles. Following surgery, a period of non-weight bearing is required which is usually anywhere from 4-8 weeks. Sometimes physical therapy is required as part of the recovery process. Statistically, Achilles tendon repairs have a high success rate and are a good alternative to living in pain.