Thanks to Greek mythology, the Achilles tendon is well known, but not by its other name: the calcaneal tendon. The myth goes that Achilles’ mother dipped her son by the foot in the River Styx prior to war in order to protect him. The spot by which she held him did not get protected, and Achilles was fatally wounded by a poison arrow that pierces his tendon.
The Achilles tendon plays a crucial role in the leg—running two-thirds the length of the leg (making it the largest tendon in the body), it holds together the calf, foot, and heel muscles to allow humans to walk. We depend on this ligament to do its job every day, but because the Achilles tendon has so much work to do, it’s not surprising that so many athletes suffer from Achilles tendonitis every year.
Achilles tendinitis occurs when the Achilles tendon is inflamed to the point of soreness and can actually cause the tendon to rupture.
Causes of Achilles Tendonitis
Although we put stress on the Achilles tendon every day, there are certain circumstances that can push the tendon to the limit. Stretching is extremely important to preventing tendonitis, in addition to wearing shoes that support you properly. People tempt Achilles tendonitis with the following activities as well:
- Running too often
- Running on hard surfaces
- Jumping a lot
- Suddenly increasing an exercise’s intensity with no warm-up
Many of these symptoms are more likely to be experienced by young people, but older people who suffer from arthritis may also be familiar with Achilles tendonitis caused by bone spurs or growths.
It’s important to note that no specific injury causes Achilles tendonitis, rather it’s repetitive stress and increased pressure that can cause the tendon to become inflamed.
Symptoms of Achilles Tendinitis
Pain in the tendon is the most immediate indicator that your Achilles tendon is inflamed, but there are other indicators as well:
- Pain in the heel when walking or running
- Tendon is painful when touched or feels bruised, stiff, or sore
- Area is swollen and warm
- You are unable to stand up on your toes
- Burning sensation in the tendon
If you experience these symptoms, you should consult your doctor, who can ascertain whether your tendon is inflamed or actually torn. Your doctor can decide the best course of action after assessing the situation with a Magnetic Resonance Imagining (MRI) or ultrasound, where he or she can identify increased blood flow to the area, tendon fibril disorganization, or partial thickness tears.
It’s important that your doctor assesses whether you have Achilles tendonitis, as the symptoms are similar to having stress fractures, nerve damage, or deep ankle injuries. Treating the actual condition will help get you back on your feet sooner.
One feature that makes Achilles tendonitis tricky to treat is that the pain may only be present at the beginning of an exercise activity. Continued activity can make the initial pain go away, possibly causing the athlete to think he or she no longer has a problem. However, continuing to exercise can make the problem worse and may actually cause a tear or rip in the tendon. A burning sensation is a clear indicator that you should cease exercise activities immediately and seek advice from your doctor.
If increase activity makes the pain worse as opposed to subside, you may be suffering from Achilles paratendonosis, which is inflammation of the fat that covers the Achilles tendon, instead of inflammation of the Achilles tendon itself.
Treatment of Achilles Tendonitis
Injuries to the Achilles tendon are slow to heal, and recovery may take as long as two to three months.
In addition to decreasing or stopping activities that cause you pain, and running or walking on softer surfaces, your doctor may suggest a number of treatments. The simplest is for you to ice the area for at least ten minutes and not more than twenty minutes every day. Icing for more than twenty minutes puts you at risk for frostbite and damaging the surrounding muscles, and icing for less time only cools the skin and not the tendon. Also, don’t ice the area before a run, as your muscles will be at risk of tearing when cooled.
Your doctor may also suggest calf exercises to help stretch the tendon and strengthen the surrounding muscles. These may include the calf stretch (wall stretch), bilateral heel drop, and single leg heel drop.
To help with inflammation as well as pain, you may purchase nonsteroidal anti-inflammatory drugs over the counter or your doctor can prescribe them. Your doctor may also choose to administer cortisone injections in severe cases, although this can cause damage to the tendon.
A treatment using low-dose sound waves, extracorporeal shock wave therapy (ESWT) is argued to help increase blood flow to the area to promote healing. With modern technological developments, the procedure can take less than ten minutes in a doctor’s office. The Food and Drug Administration is clear about how ESWT can be used for heel pain: a patient must have experienced heel pain for at least six months and tried at least three other types of treatments without relief.
Finally, surgery is an option of last resort. Surgery to treat Achilles tendonitis can mean any number of several different treatments:
- Gastrocnemius recession: This lengthens the calf muscle to reduce stress on the Achilles tendon.
- Debridement and repair: This removes the parts of the Achilles tendon that are damaged and repairs the remaining tendon—this may also include removing any bone spurs or growths.
- Debridement with tendon transfer: This is used in cases where more than 50% of the tendon is not healthy and cannot function alone. The extensor hallucis longus, which helps the big toe point and move downward, is removed to replace the Achilles tendon.
Patients who must undergo surgery can expect a recovery period as long as twelve to sixteen months and, in some cases, may be unable to ever return to competitive running or other sports.