Achilles Tendinitis

Overview

What is the Achilles tendon?

The Achilles tendon is the largest and strongest tendon in the body. It’s in the back of the heel, connecting the heel bone to the calf muscle.Tendons are the long, tough, ropy and fibrous tissues that connect muscles to bones. The Achilles tendon is named for the Greek god Achilles.The Achilles tendon helps you walk, run and jump by raising the heel off the ground. It’s very strong, but overstressing it can injure it.

What causes Achilles tendon pain?

Common causes of Achilles tendon pain are:

  • Achilles tendinitis, inflammation (irritation) of the tendon.
  • Achilles tendinosis, when the tendon starts to degenerate (break down) because of unresolved Achilles tendinitis.
  • Achilles tendon rupture, a tear or break in the tendon.

What is Achilles tendinitis?

Tendinitis is when a tendon becomes irritated or inflamed. Inflammation is the body’s response to injury or disease. Tendinitis can be very painful.It’s important to treat Achilles tendinitis. Otherwise, it can become a long-term, chronic problem, making it difficult to walk.

What are the types of Achilles tendinitis?

The two types of Achilles tendinitis describe which part of the tendon is affected:

  • Noninsertional Achilles tendinitis: The fibers in the middle of the tendon start to break down, swell and thicken. This type of Achilles tendinitis affects people who are younger and more active.
  • Insertional Achilles tendinitis: This type affects the lower part of the heel, where the tendon connects, or inserts, to the heel bone. It can affect anyone, even people who aren’t active. But it most commonly affects people who overuse the tendon, such as long-distance runners.

Who is at risk for Achilles tendon disorders?

Achilles tendon disorders are common sports injuries. People at high risk for Achilles tendon disorders include those who:

  • Play sports, especially sports that involve quick stops and starts.
  • Run or dance.
  • Have jobs that put stress on their feet and ankles, such as laborers.
  • Participate in sports less frequently (“weekend warriors”), leaving their bodies less used to the stress.

You may also be at higher risk for Achilles tendinitis because of your anatomy (body shape and structure). For example, if you have:

  • Tight or weak calf muscles.
  • Bone spur, an extra bone growth in your heel that rubs the tendon, causing pain.
  • Flat arches.
  • Overpronation, ankles that roll down and in when you walk.

How common is Achilles tendinitis?

Achilles tendinitis is a common condition. It most often affects active people and athletes.

Symptoms and Causes

What causes Achilles tendinitis?

In Achilles tendinitis, overuse of the Achilles tendon causes swelling, irritation and inflammation. You can get Achilles tendinitis by being active on your feet.It’s usually not related to a specific injury — it happens because of stressing the tendon repeatedly. Because it’s difficult to avoid using the Achilles, the body doesn’t have time to repair the injured tissue.

What are the symptoms of Achilles tendinitis?

Symptoms of Achilles tendinitis affect the lower leg above the heel. You might notice:

  • Heel pain and ankle pain.
  • Stiffness or tenderness in the tendon.
  • Leg weakness.
  • Swelling around the Achilles tendon.

You may notice more discomfort:

  • After you are active or the day after exercising.
  • As you climb stairs or go uphill.
  • In the morning, with improvement throughout the day.

Diagnosis and Tests

How is Achilles tendinitis diagnosed?

Your healthcare provider will ask you about your symptoms and recent activity. They’ll look for signs of Achilles tendinitis or Achilles tendon rupture. They will check your range of motion and look for signs of bone spurs.

What tests might I need to diagnose Achilles tendinitis?

Your provider can often diagnose Achilles tendinitis based on the physical exam alone. You may need imaging to show the condition’s details or severity.Imaging exams may include:

Management and Treatment

How is Achilles tendinitis treated?

Your provider will first recommend nonsurgical treatment. It may take a few months for the pain to get better — especially if you’ve already had symptoms for a few months.

Nonsurgical treatment methods include:

RICE method:

  • Rest: Stop doing activities that stress your tendon. Switch to low-impact activities, such as swimming, that put less stress on the Achilles tendon.
  • Ice: Put ice on your tendon for up to 20 minutes, as needed throughout the day.
  • Compression: Compress, or put pressure on, the tendon using an athletic wrap or surgical tape.
  • Elevation: To reduce swelling, lie down and raise your foot on pillows so it’s above your heart.

Protect your tendon. Avoid walking up steep inclines or overstretching the tendon, such as by standing on a ladder rung. Wear:

  • Supportive shoes, heel lifts or custom orthotics. Don’t walk barefoot.
  • Splint at night to help the Achilles tendon stay stretched while you sleep.
  • Walking boot or walking cast if the pain is severe.

Other nonsurgical treatments that can help:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Don’t take the medication for more than one month without talking to your provider.
  • Exercises you can do at home, such as calf stretches.
  • Physical therapy, which uses strengthening exercises, massage, stretching and running re-education to help you feel better and regain your strength.
  • Shockwave therapy, which uses strong sound waves to reduce pain and promote healing.

What is brisement?

Brisement is a treatment option in earlier stages of Achilles tendinitis, before it progresses to Achilles tendinosis. Providers inject anesthetic into the space around the tendon to break up scar tissue. You may need to have this procedure a few times.

Does Achilles tendinitis need surgery?

If you’ve tried nonsurgical methods for six months and you’re still in pain, talk to your provider. You may need surgery. A foot and ankle surgeon can suggest options based on your injury, age, preferences and activity level.

Surgical options include:

  • Gastrocnemius recession: The surgeon lengthens the calf (gastrocnemius) muscles.
  • Debridement and repair: If most of the tendon is healthy, the surgeon removes just the damaged part and stitches together the remaining healthy tendon. After the procedure, you’ll wear a boot or cast for a few weeks.
  • Debridement with tendon transfer: If more than half of the Achilles tendon is damaged, then there’s not enough healthy part of the Achilles tendon to function. You need an Achilles tendon transfer. Your surgeon takes the tendon that helps the big toe point down and moves it to the heel bone. Treatment gives the damaged tendon enough strength to function. You’ll still be able to move your big toe, walk and even run. But you may not be able to play sports competitively after this procedure.
  • Hydrocision TenJet®: This minimally invasive, ultrasound guided technique uses high velocity saline to break up scar tissue in the tendon. The pressurized saline acts as blade to selectively remove unhealthy tissue. This is done on an outpatient basis.

Are there complications from Achilles tendinitis surgery?

Some people still experience pain after surgery. The other complication that can occur is a wound infection. Infection can be challenging to treat because of the location of the Achilles tendon.

Prevention

How can I prevent Achilles tendinitis?

To reduce your risk of Achilles tendinitis:

  • Warm up before you exercise or play sports. Focus on stretching exercises, especially stretching your calf muscles.
  • Do a variety of exercises to avoid repetitive stress on the Achilles tendon.
  • Increase the length and intensity of your exercises slowly rather than all at once.
  • Keep your muscles active by staying in shape all year round.
  • Wear supportive shoes that fit well.
  • Avoid running uphill or on uneven ground.

If you notice symptoms of Achilles tendinitis, such as pain, stop what you’re doing and rest. Then talk to your provider about next steps.

Outlook / Prognosis

What’s the outlook for people with Achilles tendinitis?

People can recover from Achilles tendinitis. But get treatment as soon as you feel symptoms. The longer you live with the pain, the harder and longer the treatment process will be.

Most people have good results from Achilles tendinitis surgery. The factor that affects your recovery is how much of the tendon was damaged. People with a lot of tendon damage need a longer recovery period.

Physical therapy plays a big role in your rehabilitation, either as a treatment method or as part of your recovery from surgery. It can help you regain your strength and function.

Living With

How can I take care of myself if I have Achilles tendinitis?

Achilles tendinitis can be frustratingly slow to heal. It can take time for your symptoms to disappear completely. Follow your healthcare provider’s instructions, so you don’t re-injure the tendon and worsen the symptoms.

If you’re trying nonsurgical treatments to avoid or delay surgery, expect to wait a few months to see improvement. To keep the tendon healthy:

  • Attend physical therapy.
  • Avoid certain activities or sports.
  • Stretch the muscle.
  • Wear supportive shoes.

If you’re recovering from surgery, follow your provider’s instructions for the recovery period:

  • Attend physical therapy.
  • Do range-of-motion exercises to keep the tendon moving.
  • Wear your cast, splint or boot for the required period.

When should I see a healthcare provider about Achilles tendon pain?

Call your provider or go to an urgent care center if you have:

  • Symptoms that don’t improve after a few weeks.
  • Severe pain.
  • Signs of a ruptured tendon (including if you heard a popping sound).

What else should I ask my healthcare provider about Achilles tendon pain?

If you have Achilles tendon pain or Achilles tendinitis, ask your provider:

  • Do I have Achilles tendinitis?
  • What can I do to keep it from getting worse?
  • Do I have an Achilles tendon rupture?
  • What nonsurgical treatments can I try?
  • Will I need Achilles tendon surgery?
  • Will physical therapy help me?
  • How long will it take to recover from Achilles tendinitis?
  • What activities should I avoid?
  • What medications can help me feel better?

A note from Cleveland Clinic

Achilles tendon pain is common in athletes and active people. If you have Achilles tendon pain, talk to your healthcare provider. The longer you wait to take care of it, the longer it takes to treat. You can treat Achilles tendinitis using nonsurgical methods, such as avoiding certain activities, using custom orthotics and attending physical therapy. If nonsurgical treatments don’t provide relief, talk to your provider about surgery for Achilles tendinitis.

Last reviewed by a Cleveland Clinic medical professional on 05/12/2021.

References

  • American Academy of Orthopaedic Surgeons. Achilles Tendinitis. (https://orthoinfo.aaos.org/en/diseases--conditions/achilles-tendinitis) Accessed 11/9/2021.
  • American College of Foot and Ankle Surgeons. Achilles Tendon Disorders. (https://www.foothealthfacts.org/conditions/achilles-tendon-disorders) Accessed 11/9/2021.
  • American Orthopaedic Foot & Ankle Society. Orthopaedic Foot & Ankle Foundation. Achilles Tendinitis. (https://www.footcaremd.org/conditions-treatments/ankle/achilles-tendinitis) Accessed 11/9/2021.
  • Lemme NJ, Li NY, et al. Epidemiology of Achilles Tendon Ruptures in the United States: Athletic and Nonathletic Injuries From 2012 to 2016. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6259075/) _Orthop J Sports Med. _2018;6(11):2325967118808238. Accessed 11/9/2021.
  • Merck Manual Consumer Version. Achilles Tendinitis. (https://www.msdmanuals.com/home/injuries-and-poisoning/sports-injuries/achilles-tendinitis) Accessed 11/9/2021.
  • NHS. Tendonitis. (https://www.nhs.uk/conditions/tendonitis/) Accessed 11/9/2021.

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