Define Achilles Tendonitis
Achilles tendonitis is an inflammation to the Achilles tendon in the back of the ankle and can come about immediately or over time. Specifically, if you have a torn Achilles tendon, this is a serious state that needs immediate attention. In either case, it is important to treat this injury quickly and not let it continue to limit your functioning.
By: Ehren Allen, PT/Certified Manual Therapist
The Achilles tendon is the thick, rope like tissue in the back of the ankle that runs from the middle of the back of the lower leg to the heel.
This tendon is the connection of the calf (gastroc) muscle to the heel bone (calcaneus) and allows for the foot to go into plantarflexion, or the motion of lifting your heel and going up on to your toes.
An “itis” is an inflammation of the soft tissue that can cause pain, swelling, and heat in the area of irritation.
Achilles tendonitis is an injury (usually overuse injury) that will cause pain and possibly inflammation in the back of the ankle. Anyone that jumps or runs will use this tissue very frequently.
As mentioned previously, Achilles tendonitis is usually caused by repetitive movements such as running, jumping, and pushing up onto ones toes frequently. There is a direct correlation between calf muscle tightness and Achilles Tendonitis.
The symptoms can either come on immediately after a small irritation/injury or can gradually come about overtime after no specific injury.
Many times an injury can occur due to trying to over-train or push oneself too quickly with walking, running, and jumping activities. Other external forces that can lead to this injury are exercising on incorrect surfaces, poor footwear, and training on an incline.
This injury can also arise due to degeneration of this tendon overtime from overtraining for a long period of time or from having tightness in the calf muscle. In any case, it is important to seek treatment for this injury as quickly as possible to limit chronic irritation over time.
Pain and stiffness usually are the first indications that you have an injury to your Achilles tendon. The pain is typically worse in the morning and can get better throughout the day. There may also be a "cigar" shaped area of swelling over the affected area of the tendon, according to Dr. Hiram Carrasquillo of JOI.
You may also notice the pain occurs when you are pushing off of your toes when walking, running, or jumping. However, your strength should not be limited with this injury.
Heat or swelling in the area can also occur when a more acute injury.
Typically the history of the injury or signs and symptoms are sufficient for the diagnosis of this injury. Other manual tests, strength testing, and flexibility testing may be performed to rule in/out other possible injuries to the Achilles tendon.
An MRI or CT scan may be performed in cases of chronic symptoms to know the extent of degeneration or assess the tendon itself for the extent of damage to the tissue.
The treatment of acute and chronic Achilles tendonitis may differ. In the case of an acute Achilles tendonitis, where the symptoms occur in 10 days or less, it is important to apply the RICE method to decrease immediate inflammation and pain in the area.
RICE stands for:
This can help to decrease the body’s inflammatory response. It is also important to stay off the injured leg and decrease the irritation to the area.
Light stretching to the calf with a towel pulling back on the ball of the foot can help to slowly stretch the injured tendon. Once the tendon has calmed down and is not so painful, more aggressive stretching and strengthening exercises can be performed throughout the ankle to help reduce the chance of this occurring again.
Please read this article to learn more about tendonitis treatments.
For more chronic cases, or if an acute case has turned chronic, heat may be more beneficial modality. More aggressive gastroc and soleus stretching or placing the heel down in a lunge position may be warranted to loosen the tissues.
Massage or mobilization to the area will also help to break up the stiffness of the tendon. Eccentric exercises where you allow your heels to slowly lower off the edge of a step has shown to be the most beneficial to prolonged improvements in symptoms, but only when symptoms have subsided.
This allows for slow stretching to the tissue and will help to build strength of the tendon over time while decreasing irritation in the area. It is important to note that the symptoms or pain can get worse prior to improving with this treatment and can take up to 12 weeks for resolution of the symptoms. It is essential to keep up with the treatment to fully heal from this injury and return to all daily activities.
Dr. Carrasquillo states that night splints and immobilization during the day may help. There are other treatments and surgical options in some cases. Protein rich plasma injections are still controversial for this issue.
If you are interested in scheduling an appointment at JOI Rehab for physical therapy, go to: JOIonline.net or call 904-858-7045
If you want to learn more on how to treat Achilles Tendonitis, go to 5 things may cause shoulder pain
To schedule an appointment with an Orthopedic Foot and Ankle Specialist, please call 904-JOI-2000, or schedule online. New to JOI, you can now schedule and cancel follow up appointment with your physician by using the JOI Patient Portal.