Achilles tendinitis is a common condition that causes pain on the back of the leg near the heel. The achilles tendon is the largest tendon in the body connecting your calf
muscles to your heel bone. Your achilles tendon is used when you walk, run or jump. It is made to withstand a high amount of stress from these activities, but when it is overused, you can develop
tendinitis. Tendinitis is defined as inflammation of a tendon. When you are injured, your body's natural response causes inflammation. You may experience pain, swelling, or tenderness at the injured
site. There are two types of achilles tendinitis, insertional and non-insertional achilles tendinitis.
The two most common causes of Achilles tendonitis are Lack of flexibility and Overpronation. Other factors associated with Achilles tendonitis are recent changes in footwear, and changes in exercise
training schedules. Often long distance runners will have symptoms of Achilles tendonitis after increasing their mileage or increasing the amount of hill training they are doing. As people age,
tendons, like other tissues in the body, become less flexible, more rigid, and more susceptible to injury. Therefore, middle-age recreational athletes are most susceptible to Achilles
Symptoms of Achilles Tendinitis include the following. 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. If you have an Achilles
tendon rupture, you might feel a pop or snap, accompanied by a sharp pain behind your ankle. You are likely to have difficulty walking properly. If you have ruptured your Achilles tendon then surgery
is likely to be the best treatment option.
A podiatrist can usually make the diagnosis by clinical history and physical examination alone. Pain with touching or stretching the tendon is typical. There may also be a visible swelling to the
tendon. The patient frequently has difficulty plantarflexing (pushing down the ball of the foot and toes, like one would press on a gas pedal), particularly against resistance. In most cases X-rays
don't show much, as they tend to show bone more than soft tissues. But X-rays may show associated degeneration of the heel bone that is common with Achilles Tendon problems. For example, heel spurs,
calcification within the tendon, avulsion fractures, periostitis (a bruising of the outer covering of the bone) may all be seen on X-ray. In cases where we are uncertain as to the extent of the
damage to the tendon, though, an MRI scan may be necessary, which images the soft tissues better than X-rays. When the tendon is simply inflamed and not severely damaged, the problem may or may not
be visible on MRI. It depends upon the severity of the condition.
The recommended treatment for Achilles tendinitis consists of icing, gentle stretching, and modifying or limiting activity. Nonsteroidal anti-inflammatory medications (NSAIDs), such as ibuprofen or
aspirin, can reduce pain and swelling. Physical therapy and the use of an orthotic (heel lift) can also be helpful. For chronic cases where tendinosis is evident and other methods of treatment have
failed, surgery may be recommended to remove and repair the damaged tissue.
Open Achilles Tendon Surgery is the traditional Achilles tendon surgery and remains the 'gold standard' of surgery treatments. During this procedure one long incision (10 to 17 cm in length) is made
slightly on an angle on the back on your lower leg/heel. An angled incision like this one allows for the patient's comfort during future recovery during physical therapy and when transitioning back
into normal footwear. Open surgery is performed to provide the surgeon with better visibility of the Achilles tendon. This visibility allows the surgeon to remove scar tissue on the tendon,
damaged/frayed tissue and any calcium deposits or bone spurs that have formed in the ankle joint. Once this is done, the surgeon will have a full unobstructed view of the tendon tear and can
precisely re-align/suture the edges of the tear back together. An open incision this large also provides enough room for the surgeon to prepare a tendon transfer if it's required. When repairing the
tendon, non-absorbale sutures may be placed above and below the tear to make sure that the repair is as strong as possible. A small screw/anchor is used to reattach the tendon back to the heel bone
if the Achilles tendon has been ruptured completely. An open procedure with precise suturing improves overall strength of your Achilles tendon during the recovery process, making it less likely to
re-rupture in the future.
Maintaining strength and flexibility in the muscles of the calf will help reduce the risk of tendinitis. Overusing a weak or tight Achilles tendon makes you more likely to develop tendinitis.