Achilles Tendonitis

When the Achilles tendon is overloaded, it can become inflamed and start to degenerate — a condition known as Achilles tendonitis.

The Achilles tendon is the strongest and thickest tendon in the human body, connecting the calf muscles to the heel bone. It plays a key role in walking, running, climbing stairs, jumping, and standing on your toes.

There are two main types of Achilles tendonitis, depending on the location of the inflammation: in the middle of the tendon or where it attaches to the heel bone. Although it is most commonly seen in athletes, Achilles tendonitis can affect anyone. It causes heel pain, swelling, and difficulty walking, which can disrupt not only sports activities but also daily routines.

Initial treatment options for Achilles tendonitis include wearing heel lifts, taking a break from sports, and performing Achilles-specific strengthening exercises. If left untreated, the condition can lead to chronic pain.

What Is the Achilles Tendon?

The Achilles tendon is the largest and most powerful tendon in the human body. It connects the calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus), playing a crucial role in foot and ankle movement. It generates most of the force required for walking, running, jumping, and standing.

Functions of the Achilles Tendon:

• Walking and Running: It helps lift the heel off the ground and push the body forward.

• Jumping: It provides the explosive force needed for jumping.

• Balance and Support: It plays a vital role in standing and maintaining balance during daily activities.

What Is Tendonitis?

Tendonitis is the inflammation of a tendon, usually caused by repetitive movements or overuse. It is the body's natural response to injury or strain and often leads to pain, swelling, and irritation.

What Is Achilles Tendonitis?

Achilles tendonitis refers to inflammation of the Achilles tendon. There are two types, depending on which part of the tendon is affected:

1. Mid-Portion Achilles Tendonitis

Also known as non-insertional tendonitis, this type affects the middle portion of the tendon. Pain and swelling occur along the tendon, often accompanied by degeneration and thickening of the tendon fibers. It is more common in younger and active individuals.

2. Insertional Achilles Tendonitis

This type affects the lower part of the tendon, where it inserts into the heel bone. A bony growth called a Haglund’s deformity can irritate the tendon, causing inflammation and damage. It can occur in both active and inactive individuals.[Click here to learn more about Insertional Achilles Tendonitis.]

What Causes Achilles Tendonitis?

Achilles tendonitis is not usually caused by a single traumatic injury, but rather by repetitive stress on the tendon — often when the body is pushed beyond its capacity. Risk factors include:

• Sudden Increase in Activity: Increasing running distance or intensity too quickly without giving the body time to adapt.

• Tight Calf Muscles: Tight calves combined with aggressive workouts can place extra strain on the tendon.

• Bony Spurs: A Haglund’s deformity can cause constant friction at the tendon’s attachment point on the heel bone, leading to inflammation.

Symptoms of Achilles Tendonitis

• Pain: Along the tendon; in insertional tendonitis, pain is felt at the back and top of the heel.

• Swelling: Thickening and swelling of the Achilles tendon.

• Bony Enlargement: A visible bump at the lower end of the tendon in insertional tendonitis, which may grow over time.

How Is Achilles Tendonitis Diagnosed?

Diagnosis is usually made through a clinical evaluation, including a detailed history and physical examination.

• X-rays are helpful to detect bone spurs and Haglund’s deformity at the tendon’s insertion point on the heel.

• MRI scans are not always necessary but can provide detailed information about degeneration, partial tears, or the severity of the condition.

How Is Achilles Tendonitis Treated?

Achilles tendonitis is usually treated with non-surgical methods, but in some cases — especially insertional tendonitis— surgical removal of the Haglund’s deformity may be necessary. Recovery can take time, and even with early treatment, pain relief may take several weeks or even months.

1. Supportive Footwear and Orthotics

One of the first steps in treatment is placing a heel lift inside the shoe. This reduces tension and stress on the tendon, allowing it time to heal. Shoes with a softer heel counter can also help minimize irritation. Heel lifts are especially beneficial for patients with insertional tendonitis, as

they reduce friction by lifting the heel away from the back of the shoe.

2. Rest

Avoiding or minimizing activities that worsen the pain is crucial. If you regularly perform high-impact exercises like running, switching to low-impact activities like cycling, elliptical training, or swimming can help reduce strain on the tendon while keeping you active.

3. Ice Therapy

Applying ice to the most painful part of the Achilles tendon can be helpful. Use ice for up to 20 minutes at a time as needed throughout the day. Stop earlier if the skin becomes numb.

4. Pain Medication

Anti-inflammatory medications can reduce pain and swelling. However, they do not reverse tendon degeneration or thickening. Always consult your physician before using these medications for long-term relief.

5. Achilles Tendonitis Exercises

1. Calf Stretching Exercise: Stand facing a wall with one leg extended straight back, heel flat on the floor. Place the other leg forward with the knee bent. Lean toward the wall to stretch the calf and Achilles tendon. Hold for 10 seconds, relax, and repeat 20 times per leg. You should feel a firm stretch in the calf.

2. Eccentric Strengthening Protocol: This involves lengthening the muscle while it contracts. It’s recommended to start this under a physical therapist’s supervision, as improper technique may worsen the condition. Once comfortable, the exercises can be continued at home. Some discomfort is normal, but it should not be unbearable.

3. Heel Drop Exercise: Stand on the edge of a step with just the front half of your feet supported. Raise your heels, then slowly lower them below the step level. Repeat 20 times. Perform the motion slowly and with control to avoid further injury. As pain improves, add light weights in each hand to increase resistance.

4. Single-Leg Heel Drop: Once strength is improved with both feet, transition to one-legged heel drops for greater challenge.

Injection Therapies for Achilles Tendonitis

• Cortisone Injections: Only used in insertional tendonitis, and not directly into the tendon but into the retrocalcaneal bursa in front of the tendon.

• PRP and PRGF Injections:

  • PRP (Platelet-Rich Plasma): Derived from the patient’s own blood, this serum contains concentrated platelets that aid in healing.

  • PRGF (Plasma Rich in Growth Factors): An advanced version of PRP, enriched with growth factors and regenerative proteins extracted from platelets.

The choice between PRP and PRGF depends on the patient's condition and the severity of tendon damage.

What Does Achilles Tendon Pain Feel Like?

Pain is typically felt in the lower calf and heel area. It is often most intense with the first steps in the morning, then subsides slightly but persists throughout the day. The pain can worsen with activity such as running or walking.

Other symptoms may include:

• Localized swelling and tenderness

• Morning stiffness

• Increased sensitivity with movement or touch

• A visible bony bump in insertional cases

Early diagnosis and treatment are key to preventing tendon rupture.

Chronic Achilles Tendonitis – What If It Doesn’t Go Away?

If symptoms persist despite conservative treatments, surgical intervention may be considered. Surgery typically involves removing damaged tendon tissue and repairing the remaining structure. Details of surgical options are outlined below.

Surgical Treatment for Achilles Tendonitis

If non-surgical methods fail in treating insertional Achilles tendonitis, Haglund’s deformity may be surgically removed through open or minimally invasive techniques.[Visit this page for more information on Haglund deformity surgery.]

Non-insertional Achilles tendonitis rarely requires surgery, but in stubborn cases, it may be an option.

Surgical Techniques for Achilles Tendonitis

• Gastrocnemius Recession:

  
  

  In this procedure, the calf muscle is lengthened to reduce pressure on the Achilles tendon. It’s useful for patients with tight calf muscles who do not improve despite regular stretching. The recession can be done with or without tendon debridement.

• Debridement and Repair:

  
  

  If less than 50% of the tendon is damaged, the degenerated tissue is surgically removed, and the remaining healthy tendon is stitched back. For insertional cases, the bony spur is also removed, and the tendon may be reattached to the heel bone using metal or bioabsorbable screws. Recovery often involves wearing a walking boot or cast for 2 weeks or more, depending on the extent of the damage.

• Tendon Transfer and Debridement:

  
  

  If more than 50% of the tendon is damaged, tendon transfer is necessary. The FHL tendon (used for big toe flexion) is transferred to reinforce the weakened Achilles tendon. Despite how it sounds, most patients retain normal toe movement and don’t notice changes in walking or running.

Topical Creams for Achilles Tendon Pain

Several topical creams can be used to ease Achilles tendon pain:

• NSAID-based anti-inflammatory creams

• Analgesic creams

• Menthol-based gels

• Arnica-based creams

Patient Testimonials After Achilles Tendon Surgery

Real patient experiences can provide valuable insight into the recovery journey. Here are a few stories:

• Mehmet A. (45, Istanbul):“My Achilles tendon completely ruptured during sports. I couldn’t walk. Dr. Utku Erdem Özer’s detailed pre-op explanation put me at ease. I was walking again within a few weeks. I can now exercise pain-free. Highly recommended.”

• Ayşe K. (37, Ankara):“I had a severe tear that required surgery. Dr. Özer’s professionalism made the process smooth. With post-op physical therapy, I recovered quickly and now run stronger than ever.”

• Oğuzhan A. (50, Izmir):“Due to immune issues, I was worried about healing. But with Dr. Özer’s guidance, recovery went better than expected. I can now walk pain-free.”

Thank you for reading!

For more information, visit our homepage at utkuerdemozer.com.