Pain and stiffness along the Achilles tendon in the morning
Pain along the tendon or back of the heel that worsens with activity
Severe pain the day after exercising
Thickening of the tendon
Bone spur (insertional tendinitis)
Swelling that is present all the time and gets worse throughout the day with activity
Bump on the tendon or right behind the heel bone
Achilles ruptures
Feeling a snap or sudden acute pain at the back of the ankle (usually while playing sports or some other type of exercise)
Weakness when pushing off of their foot during walking or when trying to stand on tiptoe
Small bruise on the inside of the heel during the first few days
What are Achilles injuries
Achilles Tendinitis
Simply defined, tendinitis is inflammation of a tendon. Inflammation is the body’s natural response to injury or disease, and often causes swelling, pain, or irritation. Achilles tendinitis is inflammation of Achilles tendon, which connects your calf muscles to your heel bone.
There are two types of Achilles tendinitis, based upon which part of the tendon is inflamed.
Insertional Achilles Tendinitis
Insertional Achilles tendinitis involves the lower portion of the heel, where the tendon attaches (inserts) to the heel bone.
In both noninsertional and insertional Achilles tendinitis, damaged tendon fibers may also calcify (harden). Bone spurs (extra bone growth) often form with insertional Achilles tendinitis.
Tendinitis that affects the insertion of the tendon can occur at any time, even in patients who are not active. More often than not, however, it comes from years of overuse (long distance runners, sprinters).
Noninsertional Achilles Tendinitis
In noninsertional Achilles tendinitis, fibers in the middle portion of the tendon have begun to break down with tiny tears (degenerate), swell, and thicken.
Tendinitis of the middle portion of the tendon more commonly affects younger, active people.
Achilles ruptures
Although the Achilles tendon can withstand great stresses from running and jumping, it is vulnerable to injury. A rupture of the tendon is a tearing and separation of the tendon fibers so that the tendon can no longer perform its normal function.
Before you see a physician
Consider if it is ruptured or tendinitis, questions to think about include:
When did the pain begin?
Has the pain worsened over time?
What does it feel like?
Is there any weakness when pushing off?
Have you had an injury in you ankle or foot?
Reasons to see a physician and treatment options
If you suspect a rupture you should immediately consult a physician.
For tendonitis if the pain is impacting your ability to walk or exercise normally you should see a foot and ankle orthopedic surgeon to go over potential treatment options. If left untreated it could worsen and potentially lead to an Achilles rupture.
Non- surgical treatment options for Achilles ruptures
Non-surgical treatment options for Achilles Tendinitis
In most cases, nonsurgical treatment options will provide pain relief, although it may take a few months for symptoms to completely subside. Even with early treatment, the pain may last longer than 3 months. If you have had pain for several months before seeking treatment, it may take 6 months before treatment methods take effect.
Rest. The first step in reducing pain is to decrease or even stop the activities that make the pain worse. If you regularly do high-impact exercises (such as running), switching to low-impact activities will put less stress on the Achilles tendon. Cross-training activities such as biking, elliptical exercise, and swimming are low-impact options to help you stay active.
Ice. Placing ice on the most painful area of the Achilles tendon is helpful and can be done as needed throughout the day. This can be done for up to 20 minutes and should be stopped earlier if the skin becomes numb.
Exercise. The following exercise can help to strengthen the calf muscles and reduce stress on the Achilles tendon.
Calf stretch (example above)
Lean forward against a wall with one knee straight and the heel on the ground. Place the other leg in front, with the knee bent. To stretch the calf muscles and the heel cord, push your hips toward the wall in a controlled fashion. Hold the position for 10 seconds and relax. Repeat this exercise 20 times for each foot. A strong pull in the calf should be felt during the stretch.
Physical Therapy. Physical therapy is very helpful in treating Achilles tendinitis. It has proven to work better for non-insertional tendinitis than for insertional tendinitis.
Supportive shoes and orthotics. Pain from insertional Achilles tendinitis is often helped by certain shoes, as well as orthotic devices. For example, shoes that are softer at the back of the heel can reduce irritation of the tendon. In addition, heel lifts can take some strain off the tendon.
Surgical treatments for Achilles ruptures and tendinitis
Some preventions tips to consider if you have started feeling some pain in you Achilles tendon include:
Stretching- stretching your calves regularly before and after workouts can help protect you from injury
Changing shoes- some shoes such as heel can put lots of pressure on the Achilles tendon or rub causing pain and can lead to tendinitis
Changing activities- If you regularly do high-impact exercises (such as running), switching to low-impact activities will put less stress on the Achilles tendon. Cross-training activities such as biking, elliptical exercise, and swimming are low-impact options to help you stay active.
Anatomy
The Achilles tendon also known as the calcaneal tendon is a large tendon at the back of the lower leg and ankle that connects the calf muscles to the heel (calcaneus). It is the largest tendon in the body, and its strength allows us to push off with forces up to 10 times our body weight.
In tendinitis there is inflammation and swelling in this area due to irritation or disease. A rupture is due to a tear in the tendon fibers themselves.
Recovery and return to activity
Achilles tendon ruptures
Since tendons do not have a great blood supply, healing is a slow process. Patients usually can start light jogging in 3-6 months with return to sports involving cutting and jumping in 6-9 months. Full return of strength and the feeling of being normal may take more than a year.
Achilles tendinitis
In most cases, nonsurgical treatment options will provide pain relief, although it may take a few months for symptoms to completely subside. Even with early treatment, the pain may last longer than 3 months. If you have had pain for several months before seeking treatment, it may take 6 months before treatment methods take effect.
