Achilles tendinitis
To speed up the recovery time from Achilles tendonitis, utilize the RICE protocol (rest, ice, compress, and elevate), as well as seek help from your doctor.

Achilles tendinopathy is a better term for an inflamed Achilles tendon and should be used instead of Achilles tendonitis. Essentially, the tendon is weak and dysfunctional, and, as a result, it is prone to microinjury due to repeated use.

Here are some options for alleviating and managing pain and difficulties you may experience while running and in everyday life. Always consult your doctor before beginning any medical treatments, and never attempt or self-administer treatments.

  • Relative rest and modifying exercise:
    • At first, avoid hill walking/running and other activities that aggravate the Achilles. It is critical to adapt your training program and specific exercises.
  • Pain relief:
    • Nonsteroidal anti-inflammatory drugs such as acetaminophen and ibuprofen, as well as gels, may help you manage pain, so you can continue running and training, and some people find ice to be effective in reducing pain.
    • Apply ice to the affected area for 10 to 15 minutes at a time, every few hours if necessary. Please consult your doctor before taking any medications.
  • Footwear:
    • Make sure you're wearing supportive, shock-absorbing footwear. You can try a heel lift in the back of your shoe that will increase plantarflexion and, thus, offload the Achilles tendon.
  • Massage or foam rolling:
    • Work your way up the calf to relax the muscle and relieve tension on the Achilles tendon. Tissue elasticity can be improved with deep friction massage and tendon mobilization.
  • Kinesiology tape:
    • Apply kinesiology tape to the calf and Achilles tendon to relieve tension. Kinesiology tape helps stabilize the injured area by lightly adhering to the skin and applying pressure to the tissues wrapped around it.
    • This tape allows the connective tissue surrounding the affected muscle or tendon to move in sync with the rest of the body.
  • Eccentric exercises:
    • Eccentric exercises can aid in the treatment of Achilles tendonitis in its early stages.
    • Eccentric calf-strengthening exercises stiffen and lengthen the myotendinous unit, reducing neovascularization in the tendon.
      • Straight leg and bent-knee heel drop: Perform three sets of 15 reps two times a day for 12 weeks. Once you can complete these exercises without pain or discomfort, you can increase the load.

Moreover, you can try the following if you have access to sports massage therapists and medical professionals:

  • Therapeutic ultrasound:
    • In people with chronic tendon pathologies, therapeutic ultrasound reduces swelling in acute inflammatory stages of soft tissue disorders, relieves pain, and improves function. Additionally, it stimulates collagen synthesis.
  • Extracorporeal shockwave therapy (ESWT):
    • ESWT aids in the initiation of tendon regeneration, and there is strong evidence that it is effective in the treatment of chronic Achilles tendonitis. The most effective doses and duration, however, are still unknown.
  • Corticosteroid injections:
    • Corticosteroid injections can reduce pain and swelling, but they can have negative side effects and reduce tendon strength.
  • Platelet-rich plasma (PRP):
    • PRP injected at the site of injury can speed up healing and appears to increase collagen types I and III.

Surgery options for Achilles tendinopathy

If your pain does not improve after six months of nonsurgical treatment, surgery to repair your Achilles tendon may be considered. The type of surgery is determined by the location and extent of tendon damage. It may be affected by other factors such as the severity of the tendonitis.

Procedure:

  • A surgical procedure to repair a completely ruptured Achilles tendon typically entails making an incision in the back of your lower leg and stitching the torn tendon together. If the condition of the torn tendon is severe, it may be reinforced with other tendons.
  • Surgery to remove the thickened fibrous tissue from the healthy Achilles tendon can be used to treat Achilles tendonitis.
  • You may need to do physical therapy exercises after surgery to strengthen your Achilles tendon and leg muscles.

Surgical methods include:

  • Debridement and repair:
    • When less than half of the tendon is damaged, this procedure is used.
    • The goal of this procedure is to remove the damaged portion of the Achilles tendon and repair the remaining tendon with sutures or stitches.
    • Bone spurs may be removed at the same time depending on the type of Achilles tendonitis.
  • Debridement with tendon transfer:
    • When more than half of the tendon is damaged, this procedure is used.
    • To strengthen the damaged tendon, the tendon that helps the big toe point down is moved to the heel bone.
    • Some people may be unable to return to competitive sports or running depending on the extent of tendon damage.
  • Gastrocnemius recession:
    • This is a surgical procedure for lengthening the gastrocnemius muscles (calf muscles). Because tight calf muscles put additional strain on the Achilles tendon, this procedure is beneficial for people who still have difficulty flexing their feet after stretching the muscle regularly.
    • During this procedure, one of the two calf muscles is lengthened to increase ankle motion.

Although rare, complications from surgery may occur, which include:

  • Infection
  • Slow wound healing
  • Damage to nerves and soft tissues
  • Bleeding

Recent advances in treating Achilles tendonitis include:

Therapeutic laser therapy:

  • Light energy is delivered to damaged cells, stimulating intercellular activity. In a painless and time-efficient manner, the laser increases circulation and draws oxygen and nutrients to the damaged area.
  • The laser aids in the creation of an optimal healing environment by lowering inflammation, swelling, muscle spasms, stiffness, and pain.
  • One of the most significant advantages of laser therapy is that it does not require the use of drugs or surgery, and there are no side effects or risks associated with other forms of treatment.
  • Therapeutic laser therapy is an excellent supplement to traditional physical therapy treatment for Achilles tendonitis. It addresses the most common symptoms of Achilles tendonitis, including pain, swelling, and inflammation.

The majority of people have positive outcomes from surgery, and recovery usually lasts about a year. The more tendons involved, the longer the recovery period and the less likely a person will be able to resume sports activity.

Physical therapy post-surgery will be necessary to ensure complete recovery.

What is Achilles tendonitis?

Achilles tendonitis is a common condition in which the large tendon that runs down the back of your lower leg becomes inflamed and irritated.

Although the Achilles tendon can withstand high stress from running and jumping, it is susceptible to tendonitis, a condition caused by degeneration and overuse.

Two types of Achilles tendonitis:

  1. Non-insertional Achilles tendonitis:
    • Fibers in the middle of the tendon begin to tear, causing the tendon to swell and thicken. This type of tendonitis is most common in young, active people.
  2. Insertional Achilles tendonitis:
    • The tendon attaches to the heel bone in the lower part of the heel. This type of tendonitis can strike at any time, even in people who are not physically active. 
    • With insertional Achilles tendonitis, extra bone growth (bone spurs) is common.

What are the symptoms of Achilles tendonitis?

The 8 symptoms of Achilles tendonitis include:

  1. Pain in the back of the heel while walking or running
  2. Bruising, redness, or swelling of the skin in the vicinity of the inflamed area
  3. A sore Achilles tendon in the morning after putting weight on your feet for the first time after waking up
  4. Foot or ankle stiffness or difficulty moving
  5. Pain that worsens and becomes more noticeable when running, jumping, or engaging in strenuous physical activity
  6. Pain in the back of the heel, where the tendon connects with the heel bone
  7. Pain that comes back after a period of inactivity
    • people frequently experience pain, soreness, or stiffness first thing in the morning
    • they may experience Achilles pain after sitting or lying down for long periods
  8. A soft, painful lump on the tendon over time

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What causes Achilles tendonitis?

Achilles tendonitis is typically caused by repetitive stress to the tendon rather than by a specific traumatic incident. This can be seen when people push their bodies too hard and/or too soon.

Other factors can play a role in the injury, which include:

  • Leg length discrepancy
  • Overuse
  • Increasing the intensity of an activity too quickly
  • Changing training surfaces too abruptly (soft to hard)
  • Inappropriate footwear
  • Too tight or fatigued muscles
  • Not stretching enough before activity
  • Deviated or unstable rear foot axis

Additional risk factors include:

  • Obesity
  • Age
  • Diabetes
  • Insufficient warming up before exercise
  • Poorly fitting footwear while running
  • Running on uneven surfaces or uphill
  • Quickly changing your speed
  • Sports such as football, baseball, volleyball, and tennis

Certain medications may put you at risk of Achilles tendonitis, such as:

  • Glucocorticoids
  • Fluoroquinolones

If signs of Achilles tendonitis are present, continuous pressure on the lower limbs should be reduced, and treatment should be sought as soon as possible to prevent further tendon deterioration.

How to diagnose Achilles tendinitis

To diagnose Achilles tendonitis, your doctor will perform the following:

Physical examination:

  • To begin, your doctor will physically examine your calf, heel, foot, and ankle for symptoms of Achilles tendinitis and will ask you questions about how you were injured.
  • Your doctor will palpate the affected area to pinpoint the source of the pain or discomfort.

Subsequently, they may order imaging tests to confirm the diagnosis of Achilles tendinitis, which include:

  • X-rays: For images of the leg bones and foot (to check for bone calcification)
  • Magnetic resonance imaging scans: To detect tendon ruptures or tissue degeneration
  • Ultrasound: To check for tendon damage or inflammation

As a home remedy, you may be advised to use the RICE protocol, which stands for Rest, Ice, Compression (with bandage), and Elevation and is usually effective in treating Achilles tendonitis.

How can I prevent Achilles tendonitis?

The two most important factors are having strong calf muscles and keeping a close eye on your workload, which can be a difficult balance to strike. The key is to keep your calf muscles strong, but the challenge for runners is to incorporate that into their training routine.

  • When you combine strength training with a regular running load, you may experience overload, which degrades the tendon and causes the problem. You must balance the load on the tendon, which includes both your gym workouts and running.
  • Rest days are essential, as is not overloading your weekly training workload.
  • One of the major risk factors is not getting two days of rest per week. Having less than that is linked to Achilles' issues.

The calf can be difficult to target with strength training, but various calf raises should be enough to hit both the deep and superficial muscles. Choose your calf raises based on the location of the pain.

  • If pain is in the middle of the tendon, heel raises over a step are beneficial because they work the entire range of motion of the muscle.
  • If it's the insertion (where it connects to your heel), heel raises on a flat surface are preferable at first. Include raises over a step later.
  • Other exercises include bent-knee heel raises, which are surprisingly difficult, and seated heel raises with a weight on your leg, which may be difficult but beneficial.
  • To target your calf muscles, you can use a leg press machine with your heels over the end.
  • Don't skimp on the rehab time; it takes time to increase calf muscle strength.

The goal is to work up to lifting 50 percent of your body weight on your back during calf raises, similar to carrying a rucksack. However, it should be done in due course.

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Medically Reviewed on 12/7/2021
References
Image Source: iStock Images

A treatment algorithm for managing Achilles tendinopathy: new treatment options: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2658946/

Achilles Tendinitis: https://orthoinfo.aaos.org/en/diseases--conditions/achilles-tendinitis/

Achilles tendinopathy: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/achilles-tendonitis