Overview
Achilles tendinitis is an overuse injury that affects the Achilles tendon, the band of tissue connecting calf muscles at the back of the lower leg to the heel bone. It typically occurs in runners who have increased the intensity or duration of their runs or in middle-aged people who participate in sports only on weekends. Symptoms include mild ache in the back of the leg or above the heel, tenderness or stiffness, and episodes of severe pain after prolonged running or other activities. Treatment usually involves simple, at-home care under a doctor's supervision, but severe cases may require surgical repair. Risk factors for Achilles tendinitis include age, physical problems like flat feet or tight calf muscles, and medical conditions like psoriasis or high blood pressure.
Understanding the disease
Symptoms
The symptoms of Achilles tendinitis typically include a mild ache in the back of the leg or above the heel after running or other sports activity. Episodes of more-severe pain may occur after prolonged running, stair climbing, or sprinting. Other symptoms may include tenderness or stiffness, especially in the morning, which usually improves with mild activity. If you experience persistent pain around the Achilles tendon, it is important to consult your doctor.
Risk Factors
The risk factors for developing Achilles tendinitis include:
- Age: Achilles tendinitis is more common as you age.
- Physical problems: A naturally flat arch in your foot can put more strain on the Achilles tendon. Obesity and tight calf muscles also can increase tendon strain.
- Training choices: Running in worn-out shoes can increase your risk of Achilles tendinitis. Tendon pain occurs more frequently in cold weather than in warm weather, and running on hilly terrain also can predispose you to Achilles injury.
- Medical conditions: People who have psoriasis or high blood pressure are at higher risk of developing Achilles tendinitis.
- Certain medications: Certain types of antibiotics, called fluoroquinolones, have been associated with higher rates of Achilles tendinitis.
- Certain antibiotics: Fluoroquinolone antibiotics, such as ciprofloxacin (Cipro) or levofloxacin (Levaquin), increase the risk of Achilles tendon rupture. It is important to note that ruptures often occur due to a sudden increase in the stress on your Achilles tendon, such as increasing the intensity of sports participation or falling from a height.
Development
Achilles tendinitis develops as a result of repetitive or intense strain on the Achilles tendon, which connects the calf muscles to the heel bone. This overuse injury commonly occurs in runners who have increased the intensity or duration of their runs, as well as in middle-aged individuals who participate in sports only on weekends. Various factors can contribute to the development of Achilles tendinitis, such as a naturally flat arch in the foot, obesity, tight calf muscles, wearing worn-out shoes, running in cold weather, and running on hilly terrain. Additionally, certain medical conditions and medications, such as high blood pressure and fluoroquinolone antibiotics, can also increase the risk of developing Achilles tendinitis.
Assessment and Diagnosis
Triage
You should see a doctor if Achilles tendinitis is suspected if you experience persistent pain around the Achilles tendon. If the pain or disability is severe, seek immediate medical attention, as you may have a torn (ruptured) Achilles tendon.
Diagnosis
To diagnose Achilles tendinitis, a doctor will typically perform a physical exam to locate the source of pain, tenderness, or swelling in the affected area. They will evaluate the flexibility, alignment, range of motion, and reflexes of the foot and ankle. Imaging tests, such as X-rays, ultrasound, or MRI, may also be ordered to assess the condition and rule out other potential causes of symptoms.
Management and Treatment
Complications
Potential complications of Achilles tendinitis include weakening of the tendon, making it more susceptible to a tear (rupture). A ruptured Achilles tendon is a painful injury that usually requires surgical repair.
Prevention
Achilles tendinitis can be prevented by taking certain measures to reduce the risk. These measures include increasing activity level gradually, taking it easy and avoiding activities that place excessive stress on the tendons, stretching and strengthening calf muscles, varying exercises, choosing appropriate shoes, stretching daily, and strengthening calf muscles. In addition, cross-training and being mindful of running surfaces can also help prevent Achilles tendinitis.
Home Remedies
For Achilles tendinitis, home remedies can help alleviate pain and promote healing. Here are some suggestions:
- Rest: Reduce or temporarily stop activities that cause pain or discomfort in the affected area.
- Ice: Apply ice packs wrapped in a cloth to the affected area for 15-20 minutes, several times a day. This can help reduce pain and inflammation.
- Compression: Wearing a compressive bandage or support around the affected area can help reduce swelling and provide additional stability.
- Elevation: Elevate the affected leg above the level of your heart to help reduce swelling.
- Over-the-counter pain relievers: Taking nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help reduce pain and inflammation.
- Stretching: Gentle stretching exercises for the calf muscles and Achilles tendon can help improve flexibility and reduce stiffness. Be careful not to bounce during the stretch and avoid forceful stretches.
- Heel lifts: If your shoes are not supportive enough, try using heel lifts or inserts to provide additional cushioning and support.
- Massage: Soft tissue massage or gentle stretching of the calf muscles and Achilles tendon can help improve circulation and promote healing.
- Physical therapy: A physical therapist can provide guidance on specific exercises and techniques to improve strength, flexibility, and reduce pain.
- Warm bath: Soaking your foot in a warm bath can help alleviate pain and relax the muscles. Remember to consult your doctor before starting any new treatment, and follow their advice and recommendations.
Treatment
To treat Achilles tendinitis, self-care measures such as the R.I.C.E. approach can be effective:
- Rest: avoid exercise or switch to a low-impact activity. In severe cases, you may need to wear a walking boot and use crutches.
- Ice: apply an ice pack to the tendon for about 15 minutes after exercising or when you experience pain.
- Compression: use wraps or compressive elastic bandages to reduce swelling and limit tendon movement.
- Elevation: elevate the affected foot above the level of your heart to minimize swelling, especially during sleep. Additionally, medications like ibuprofen or naproxen can help reduce inflammation and relieve pain. If symptoms persist or are severe, consult with a doctor who may recommend physical therapy, eccentric strengthening exercises, orthotic devices, or in some cases, surgery.
Preparing for medical consultation
To prepare for an appointment for Achilles tendinitis, you should:
- Write a list of your symptoms, including when and how they occurred.
- Provide information about any past medical problems you have.
- Make a list of all medications and dietary supplements you take, including doses.
- Prepare a list of questions to ask your doctor.
- Be ready to discuss your daily activities, including sports or exercise you participate in, and any factors that may contribute to your condition.
- Consider writing down the type of shoes you wear during exercise.
- If you're going to see a specialist, ask your family doctor for a referral. Remember to communicate openly with your doctor about your symptoms, activities, and any concerns you may have. This will help them provide the most appropriate treatment plan for your Achilles tendinitis.