Achilles Tendinitis Treatments: Comprehensive Guide

Pain and stiffness in the back of the ankle can mean different things. If there's inflammation, this could be a sign of Achilles tendinitis. This condition can persist for months or even years when left untreated. Luckily, most conservative methods like at-home or physical therapies work with tendinitis management.

This article tackles everything to know about Achilles tendinitis, from its common distinction from other injuries to causes, symptoms, diagnosis, and treatment. We'll also explore how physical therapy helps manage pain and prevent the condition from becoming chronic.

What Is Achilles Tendinitis?

Achilles tendinitis, also spelled as "tendonitis", is an overuse injury of the Achilles tendon common among middle-aged and elderly patients. It causes pain, stiffness, and tenderness in the back of the heel due to repetitive stress and trauma.

The Achilles tendon connects the calf muscles to your heel bone, allowing you to walk, run, and jump. When this tendon becomes inflamed, it’s called Achilles tendinitis. It's important to know this as this condition is often mistaken for Achilles tendon rupture and tendinopathy. Essentially, these conditions differ in the nature of the tendon damage. Here's a breakdown.

• Achilles tendinitis involves acute inflammation of the Achilles tendon, with pain often felt as soreness.
• Achilles tendinopathy indicates chronic degenerative changes in the tendon and is more common in terms of diagnosis.
• Achilles tendon ruptures are complete or partial tears of the Achilles tendon, resulting in sudden, severe pain and difficulty walking.

Achilles tendinitis can eventually turn into cartiligenous and bony metaplasia, making the Achilles tendon even stiffer and more painful. This happens when normal tissue, like tendon, starts to turn into cartilage or bony-like material.

Causes of Achilles Tendonitis

The primary cause of Achilles tendonitis is overuse injury often stemming from increased physical activity, especially in sports like running, basketball, or tennis. Several other factors can contribute or worsen its symptoms, including:

• Tight calf muscles
• Improper footwear
• Sudden increases in exercise intensity
• Underlying musculoskeletal conditions
• Ageing
• Lack of muscle tone

It was previously believed that tendonitis can progress into tendinopathy. However, current research suggests a reversal of this understanding. It was found that tendinopathy triggers the inflammatory response or tendinitis. This makes sense given the structural changes associated with the degenerative condition and damaged tendon.

This shift in perspective has significant implications for the diagnosis, treatment, and prevention of Achilles tendon problems.

Types of Achilles Tendinitis

There are two main types of Achilles tendinitis, classified according to the location of the inflammation within the tendon.

Insertional Achilles Tendinitis

This occurs when the tendon inserts into the heel bone, often associated with bone spurs (small bony growths). It tightens the calf muscles to your heel, putting more stress on the Achilles tendon insertion.

Insertional Achilles tendinitis is more common in older people. Other factors contributing to insertional Achilles tendinitis are:

• Obesity
• Certain medications (like corticosteroids)
• Underlying health conditions

Noninsertional Achilles Tendinitis

Meanwhile, noninsertional Achilles tendinitis affects the middle portion of the Achilles tendon rather than at the point where it attaches to the heel. It is still a result of overuse injury from strain and increased physical activity.

This type of Achilles tendinitis is more common among active, younger athletes, especially runners. Rapidly increasing the intensity or duration of exercise or sports can lead to this inflammation. Issues with foot structure, like flat feet or high arches, can also contribute. In some cases, there will be physical signs of swelling in the affected area.

The symptoms of both types of Achilles tendinitis can be similar, especially in the morning or after periods of inactivity.

Symptoms of Achilles Tendinitis

Symptoms of Achilles tendinitis often manifest as pain in the back of your lower leg above your heel. You might also notice the following signs:

• Sharp pain in the back of the heel
• Stiffness in the morning
• Tenderness in the Achilles tendon
• Swelling in the affected area
• Difficulty walking, running, or jumping
• Leg weakness

How Is Achilles Tendinitis Diagnosed?

Diagnosing Achilles tendinitis usually begins with a thorough physical examination. A doctor will assess your symptoms and perform tests to evaluate your range of motion and flexibility in the affected area.

Additionally, imaging studies may be used to rule out other conditions and diagnose Achilles tendinitis. This includes:

• X-rays. While primarily used to visualise bones, X-rays can help identify bone spurs or calcification within the tendon.
• Ultrasound. This imaging technique provides real-time images of the tendon, allowing for visualisation of inflammation, thickening, or tears.
• Magnetic Resonance Imaging (MRI). MRI offers detailed images of soft tissues, providing a comprehensive evaluation of the Achilles tendon and surrounding structures. It is particularly useful for diagnosing more severe cases or complex injuries.

Who Are Most Prone to Achilles Tendinitis?

Athletes, particularly runners and jumpers, are at a higher risk of developing Achilles tendinitis. Individuals with flat feet, high arches, or those who have experienced previous tendon injuries are also more susceptible.

Achilles Tendinitis Treatment

There isn't a specific cure for Achilles tendinitis. However, proper treatment and care can help you manage it effectively. Achilles tendinitis treatment aims to relieve pain, reduce inflammation, and eventually heal. Non-surgical options are often the first line of treatment in treating Achilles tendinitis.

Medication

Over-the-counter pain relievers like ibuprofen or naproxen can help alleviate pain and inflammation. In some cases, your doctor may prescribe stronger anti-inflammatory medications.

Physical Therapy

Physical therapy is beneficial in Achilles tendinitis recovery. Our skilled physical therapists at Phoenix Rehab can help you get back on your feet. We specialise in treating various conditions, including Achilles tendinitis, and have experienced physiotherapists for knee pain in Singapore.

Our personalised physiotherapy treatment plans incorporate the following:

Exercises

These exercises focus on strengthening the calf muscles and improving flexibility in the ankle joint.

Orthotic devices

Your physical therapist may recommend orthotics to provide additional support for your foot and ankle.

Ultrasound and Other Modalities

These modalities help reduce inflammation and promote healing in the affected area.

Shockwave Therapy (ESWT)

This non-invasive treatment uses shock waves to stimulate healing in the tendon.

Injections (Corticosteroids or PRP)

Other Achilles Tendinitis treatments involve injections of corticosteroids or platelet-rich plasma (PRP) which may reduce inflammation and promote healing, although their effectiveness is still debated.

Achilles Tendinitis Surgery

Achilles tendon surgery is typically reserved for when conservative treatments prove ineffective for severe Achilles tendinitis or in cases of a ruptured tendon.

Surgical procedures for Achilles tendon issues vary depending on the specific condition. These may include:

• Achilles tendon repair: This involves surgically mending a ruptured or severely damaged tendon.
• Gastrocnemius recession: Lengthening the calf muscle to reduce tension on the Achilles tendon.
• Debridement: Removing damaged or inflamed tissue from the tendon.
• Achilles tendon insertion repair: Addressing issues at the point where the tendon connects to the heel bone.

Complex procedures like Achilles tendinopathy surgery may be necessary for chronic and degenerative conditions affecting the tendon.

The choice of surgical procedure depends on factors such as the severity of the injury, the patient's age, activity level, and overall health. Post-surgical recovery typically involves immobilisation, physical therapy, and gradual weight-bearing to restore strength and flexibility.

What You Can Do at Home

You can help manage Achilles tendinitis symptoms at home by following the RICE method:

• Rest. Avoid activities that aggravate the condition.
• Ice. Wrap an ice pack and place it on the painful area for about 15-20 minutes several times a day. Remove sooner if the skin gets numb.
• Compression. Use a compression bandage to reduce swelling.
• Elevation. Elevate your foot to reduce swelling.

However, it's also essential to engage in light activity to maintain your strength and prevent muscle atrophy. Low-impact exercises like swimming, cycling, or water aerobics can be beneficial as well.

Always listen to your body and avoid activities that cause pain or discomfort. Consulting with a physical therapist can provide guidance on appropriate exercises and help you develop a recovery plan tailored to your needs.

When to Visit Your Doctor

To help your doctor diagnose and treat your Achilles tendinitis, be prepared to describe your symptoms in detail, including when the pain started, its severity, and any activities that worsen it. Bring a list of medications you're taking and any previous injuries or medical conditions.

If home remedies don't work, consult a doctor if:

• Your pain persists or worsens despite home treatment for several weeks.
• You experience severe pain, swelling, or redness in the Achilles tendon area.
• You hear a popping sound or feel a sudden sharp pain in your Achilles tendon, which could indicate a rupture.
• You have difficulty walking or putting weight on your affected foot.
• You develop signs of infection.

Signs of Infection

While rare, it's safer to know the signs of infection in the Achilles tendon area. An infection can complicate the healing process and potentially lead to more serious health issues. These may include:

• Increased pain and swelling, beyond the typical discomfort
• Redness and warmth around the affected area
• Pus or discharge oozing from the tendon or surrounding skin
• Fever, a general feeling of unwellness
• Red streaks extending from the affected area towards the heart

Early diagnosis and treatment can prevent the condition from worsening and aid in a faster recovery.

How Can I Prevent Achilles Tendinitis?

Preventing Achilles tendinitis involves a combination of proper exercise habits, footwear choices, and overall foot care. Here are some key preventive measures:

1. Gradually increase the intensity and duration of your workouts to allow your body to adapt.
2. Incorporate stretching and warm-up exercises before activity, and cool-down stretches afterward.
3. Wear shoes that provide adequate support and cushioning, and replace them regularly.
4. Regular calf muscle strengthening exercises can help absorb shock and reduce stress on the Achilles tendon.
5. Maintain a healthy weight. Excess weight puts additional strain on your Achilles tendon.
6. Vary your workouts to avoid repetitive stress on the Achilles tendon.
7. Listen to your body. Pay attention to any pain or discomfort and rest when needed.

Conclusion

Achilles tendinitis can be both manageable and painful. With proper treatment and self-care, most patients can recover fully and get back to their activities. Early diagnosis and treatment are key to preventing complications. If you experience persistent heel pain or discomfort, consult with a healthcare professional or skilled physical therapist for a proper diagnosis and appropriate treatment plan.