Achilles Tendinitis

What is Achilles Tendinitis

Achilles tendinitis refers to the inflammation of the Achilles tendon, which connects the calf muscles to the heel bone. This tendon is a band of tissue at the back of the ankle and above the heel.

The condition often arises from the exertion of force or repeated stress where the tendon attaches to the heel bone. Over time, this can result in the wearing and tearing of the tendon.

Insertional Achilles tendinitis is a form of this condition where the degeneration occurs directly at the tendon’s insertion into the heel bone​​.

Symptoms

Achilles tendinitis presents with various symptoms that primarily affect the heel region.

• Pain and Tenderness at the Back of the Heel: Individuals may experience pain in the area where the Achilles tendon attaches to the heel. This pain often intensifies with physical activity.
• Tenderness to Palpation: Upon touching or applying pressure to the Achilles tendon, one may notice tenderness or discomfort.
• Swelling Around the Heel Region: Swelling is a common symptom, indicating inflammation of the tendon.

Causes and Risk Factors

Achilles tendinitis arises from several causes and risk factors:

• Repetitive or Intense Strain
  The condition is often caused by repetitive or intense strain on the Achilles tendon. Activities like walking, running, jumping, or pushing up on the toes can contribute to this strain.
• Age-Related Weakening
  The structure of the Achilles tendon weakens with age, making it more susceptible to injury. This is especially notable in individuals who may participate in sports occasionally or who have suddenly increased the intensity of their running programmes.
• Certain Physical Attributes
  Certain physical attributes, such as a naturally flat arch in the foot, obesity, and tight calf muscles, can increase the strain on the Achilles tendon.
• Inappropriate Training Practices
  Running in worn-out shoes, engaging in activities in cold weather, or running on hilly terrain can also increase the risk.
• Certain Medical Conditions
  Certain medical conditions, such as psoriasis, have been associated with a higher incidence of Achilles tendinitis.
• Use of Certain Medications
  The use of certain types of antibiotics, specifically fluoroquinolones, has been associated with higher rates of Achilles tendinitis​​.

Non-Surgical Treatment Options

Several non-surgical methods are available for treating Achilles tendinitis, focusing on relieving symptoms and promoting healing.

• Physical Therapy
  The Achilles tendinitis specialist may suggest specific stretching and strengthening exercises to aid in healing. An example of an exercise may be eccentric strengthening, involving the slow lowering of a weight after raising it, which can help strengthen the Achilles tendon and its supporting structures.
• Medication
  Medicines like paracetamol can be used for pain relief. In some cases, prescription medications such as Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) may be recommended to reduce inflammation and alleviate pain​​​​.
• Splints, Braces and Orthotic Devices
  Splints or braces may be used to decrease stress on the injured tissues. Shoe inserts or wedges that elevate the heel can also help reduce strain on the tendon and provide cushioning to lessen the force exerted on the Achilles tendon.
• Platelet Rich Plasma (PRP) Injections
  For recalcitrant injuries, PRP injections are sometimes used to improve the healing process. They are considered an alternative before surgical solutions​​.
• Shockwave Therapy
  Physical therapy may include pulsed ultrasound or shockwave therapy to increase blood flow and promote the healing of the injured tendons​​.

Surgical Treatment Options

When non-surgical treatments for Achilles tendinitis are not effective, surgical intervention may be necessary. These are primarily focused on repairing and restoring the tendon.

Removal of Inflamed Tissue and Abnormal Areas

This surgery often involves removing the inflamed tissue and abnormal areas of the tendon. This helps in reducing irritation and pain while allowing for the regeneration of healthier tendon tissue.

Repair of Torn Tendon

In cases of severe tearing, surgery can help repair the torn portions of the Achilles tendon. This repair can help restore the tendon’s strength and functionality.

Tendon Lengthening

In certain cases, surgery may involve lengthening the tendon, especially if a shortened and tight tendon contributes to the pain.

Prevention Strategies

Certain preventative strategies can help reduce the risk of developing Achilles tendinitis.

• Avoiding Strenuous Activities: Avoid activities that place excessive stress on the tendons, such as hill running. Cease activities that cause pain to minimise the risk of exacerbating the injury.
• Gradual Increase in Activity: Slowly and progressively increase the duration and intensity of exercise, especially if you are starting a new exercise regimen.
• Appropriate Footwear to Support the Feet and Ankles: Select shoes that provide adequate cushioning for the heel and firm arch support to reduce tension in the Achilles tendon. Regularly replacing worn-out shoes is necessary to maintain proper support.
• Regular Stretching: Daily stretching of the calf muscles and Achilles tendon, especially before and after exercise, can help maintain flexibility and prevent tendinitis recurrence.
• Strengthening Exercises: Exercises may involve those to strengthen the calf muscles. Stronger calf muscles can better handle stresses encountered during activity and exercise, reducing the load on the Achilles tendon.