Common disorders of the Achilles tendon

The Achilles tendon is a band of tissue that connects the calf muscle to the heel bone. Sometimes referred to as the “heel cord” this tissue raises the heel from the ground when walking. There are two common disorders of the Achilles tendon – Achilles Tendonitis and Achilles Tendonosis.

The two disorders are related and Achilles Tendonosis is a result of untreated Achilles Tendonitis. Achilles tendonitis is common is recreational athletes but can happen to anyone. If the Achilles tendon is overused, it can become inflamed, which can lead to pain and swelling of the ankle. 

Symptoms of Achilles tendonitis

• pain behind the heel
• pain after a period of inactivity
• pain while running or jumping
• stiffness, soreness or tenderness in the tendon (directly above the heel to just below the calf muscle)
• Tender to the touch in the same region
• Enlarged tendon, nodules may develop on the tendon increasing the size

Causes:

Achilles tendonitis is an overuse disorder typically caused by a sudden increase of activity (commonly with repetitive movements). Microscopic tears occur and if the activity causing the injury is continued the tears will not heal. People with a flattening of the arch or excessive pronation are more likely to develop Achilles tendonitis and tendonosis. This is because there is a greater demand on the Achilles tendon when walking. Wearing proper supportive footwear is important to promote healing and avoid future injuries. There are two main causes of Achilles tendonitis: lack of flexibility and over-pronation, but it can be caused by other factors as well. 

Recent changes in footwear and changes in exercise routines can contribute to the development of Achilles tendonitis.  Achilles tendonitis is most commonly found in middle-aged individuals because as we age, our tendons become less flexible and in turn, more susceptible to injury. Sometimes degeneration involves the location where the tendon connects to the heel bone. In rare, chronic degeneration, cases it is possible that a rupture of the tendon will result.

Diagnosis:

A doctor will evaluate the condition and range of motion of the tendon. Other imaging devices may be used to evaluate the condition of the tendon such as x-rays.

Treatment:

Based on the degree of damage and the length of time the patient has been experiencing these conditions different treatments are used. In the early stages or during a sudden inflammation treatment may include:

• Rest and immobilization
  • The use of a cast or temporary device may be used to promote healing
• Ice
  • Used to reduce the swelling due to inflammation
• Pain relievers/anti-inflammatory drugs
  • Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen
• Proper footwear and/or custom orthotics
  • If over-pronation or an abnormal gait is an issue, an evaluation or examination should be performed and prescription orthotics may be necessary
• Night splints
  • These can assist by preventing the tendon from becoming stiff over night or long periods of rest
• Physical therapy
  • Some exercises, stretching and massage may be beneficial in recovery

Surgery:

When non-surgical techniques do not restore the tendon surgery may be required. Based on the extent of the injury and age of the patient the surgeon will select the appropriate procedure to repair the tendon.

Prevention:

Proper stretching and footwear will help prevent injury/re-injury. If you have an abnormal gait, or walking pattern, custom orthotics may be necessary.

Other Notes: Achilles Tendon Rupture