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Achilles Tendinopathy

(Achilles Tendonitis; Achilles Tendinosis)

Definition

Tendons connect muscle to bone and often connect near a joint. Tendinopathy is an injury to the tendon. It can cause pain and swelling and makes it difficult to move. Tendinopathy may be:
  • Tendonitis—inflammation of the tendon
  • Tendinosis—tiny tears in the tendon with no significant inflammation
The achilles tendon connects the calf muscle to the heel bone. An achilles tendinopathy is pain in this tendon.
Achilles Tendonitis
Achilles Tendonitis
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Causes

Tendinopathy is generally caused by overuse of a muscle-tendon unit. Over time, the strain on the tendon causes structural changes within the tendon itself.
Overuse of the Achilles tendon can occur with activities such as:
  • Increasing your speed or running long distances too quickly
  • Suddenly adding strenuous hills or stair climbing to your exercise routine
  • Doing too much too soon after taking time away from exercising
  • A sudden or violent contraction of the calf muscles, such as during an all-out sprint
  • Running too much
  • Lack of flexibility of the calf muscles

Risk Factors

Factors that increase your risk of getting Achilles tendinopathy include:
  • Improper or badly worn footwear
  • Inflexibility of the calf muscles
  • An improper training program—such as increasing intensity too quickly
  • Increasing age—normal wear and tear can make the tendon more vulnerable to injury

Symptoms

Symptoms of tendinopathy may include:
  • Tenderness—usually just above the heel bone and often more noticeable in the morning
  • Stiffness that gradually eases as the tendon is warmed-up
  • Pain after activity that gradually worsens
  • Radiating or localized pain along the tendon during and/or after running
  • Swelling in the area of the achilles tendon
  • Pain at the back of the ankle

Diagnosis

The doctor will ask about your symptoms and exercise habits. A physical exam will be done. Your doctor will likely make a diagnosis based on the exam and history.
Further test may be ordered if the injury is severe or is not healing as expected. Images of the bones and tendons may be taken with:

Treatment

Tendinopathy and the associated pain may take months to resolve. It can be frustrating but it is important to follow through with recommended treatment.

Rest and Ice

Rest and ice are the first steps. Take a break from any activity that causes pain. Switch to activities that do not put stress on the tendon. Avoid uphill and irregular surfaces. Swimming is a good option. Once the pain has gone, gradually increase your activity levels.
Place ice or an ice pack on the area for 15-20 minutes at a time. This can help the first few days after the injury. It may also help after activity, if you have activity related pain.

Foot and Ankle Support

You may be advised to wear a shoe insert. It will place your foot in the correct position for walking and running.
Taping your ankle during activity may also help. Talk to your doctor or a physical therapist before using this option. They can show you the proper way to wrap your foot.

Physical Therapy

More severe or recurring injuries may need physical therapy. Therapy may include:

Medications

To help manage pain your doctor may recommend:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen
  • Topical pain relievers that are applied to the skin
  • Prescription pain relievers
If you are diagnosed with this condition, follow your doctor's instructions.
If you are diagnosed with this condition, follow your doctor's instructions.

Prevention

To decrease your chances of getting achilles tendonitis:
  • Wear appropriate footwear for your sport.
  • Do not use shoes beyond the recommended duration. This will depend on:
    • How frequently you exercise
    • The surface on which you exercise
    • The conditions in which you exercise
  • Gradually add hill work, stairs, speed, and distance to your routine.
  • Stretch and strengthen the calf muscles regularly.

RESOURCES

American Academy of Orthopaedic Surgeons http://www.aaos.org

Amercian College of Sports Medicine http://acsm.org

CANADIAN RESOURCES

Canadian Orthopaedic Association http://www.coa-aco.org

Canadian Orthopaedic Foundation http://www.canorth.org

References

Achilles tendinopathy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated March 18, 2013. Accessed March 25, 2013.

Achilles tendinitis. American Academy of Orthopaedic Surgeons Ortho Info website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00147. Updated June 2010. Accessed March 25, 2013.

Common disorders of the achilles tendon. American College of Foot and Ankle Surgeons Foot Health Facts website. Available at: http://www.foothealthfacts.org/footankleinfo/achilles-tendon.htm. Updated December 18, 2009. Accessed March 25, 2013.

de Jonge S, van den Berg C, de Vos RJ, et al. Incidence of midportion Achilles tendinopathy in the general population. Br J Sports Med. 2011;45(13):1026-1028.

Irwin TA. Current concepts review: insertional achilles tendinopathy. Foot Ankle Int. 2010;31(10):933-939.

10/26/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Massey T, Derry S, Moore R, McQuay H. Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev. 2010;(6):CD007402.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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