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(Achilles Tendonitis; Achilles Tendinosis)

Definition

The Achilles tendon connects the calf muscle at the heel bone. Achilles tendinopathy is pain in this tendon.

Achilles Tendonitis
Achilles Tendonitis
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Causes

The exact cause is not known. It is thought to be from overuse from:

  • Increasing speed or running long distances too quickly
  • Suddenly adding hills or stair climbing to an exercise routine
  • Stressing the calf muscles too soon after taking time away from exercising
  • Putting sudden stress on the calf muscles when they are not ready for stress

Risk Factors

This problem is more common in men and older adults. Other things that may raise the risk are:

  • Certain lower leg problems, such as lack of flexibility, poor range of motion, or a foot that turns inward too much
  • Certain health problems, such as obesity and diabetes
  • A poor training program, such as activity on hard surfaces or hills
  • Wearing poor footwear
  • Certain medicines, such as corticosteroids

Symptoms

Symptoms of tendinopathy may include:

  • Pain and stiffness above the heel bone
  • Problems that happen when bearing weight after rest, such as after sleeping
  • Swelling at the tendon
  • Problems wearing shoes
  • Decreased strength in the tendon

Diagnosis

The doctor will ask about your symptoms and health history. You will be asked about the activities that you do. A physical exam will be done. It will focus on your lower leg. This is often enough to make the diagnosis.

If the diagnosis is unclear, images may be taken. This can be done with

Treatment

Treatment depends on the tendon and how badly it is damaged. Options are:

  • Supportive care with rest and ice
  • Ankle taping to support the tendon
  • Shoe inserts
  • Medicines to ease pain and swelling
  • Physical therapy
  • Extracorporeal shockwave therapy (ESWT) to stimulate healing

Some people may need surgery when other methods do not help.

Prevention

This problem may be prevented by:

  • Wearing proper footwear
  • Slowly increasing activities
  • Stretching and strengthening the calf muscles

RESOURCES

American College of Sports Medicine  http://acsm.org 

OrthoInfo—American Academy of Orthopaedic Surgeons  http://orthoinfo.org 

CANADIAN RESOURCES

Canadian Orthopaedic Association  http://www.coa-aco.org 

Canadian Orthopaedic Foundation  http://www.canorth.org 

References

Achilles tendinitis. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00147. Updated June 2010. Accessed July 29, 2020.

Achilles tendinopathy. EBSCO DynaMed website. Available at:  https://www.dynamed.com/condition/achilles-tendinopathy  . Updated April 30, 2018. Accessed July 29, 2020.

Achilles tendon disorders. Foot Health Facts—American College of Foot and Ankle Surgeons website. Available at: http://www.foothealthfacts.org/footankleinfo/achilles-tendon.htm. Accessed July 29, 2020.

Derry S, Moore RA, Gaskell H, McIntyre M, Wiffen PJ. Topical NSAIDS for acute musculoskeletal pain in adults. Cochrane Database of Syst Rev. 2015;(6):CD007402.

Maffulli N, Via AG, et al. Chronic Achilles Tendon Disorders: Tendinopathy and Chronic Rupture. Clin Sports Med. 2015 Oct;34(4):607-624.

McCormack JR, Underwood FB, Slaven EJ. Eccentric exercise versus eccentric exercise and soft tissue treatment (Astym) in the management of insertional Achilles Tendinopathy: A Randomized Controlled Trial. Sports Health.2016;8(3):230-237.

Zwiers R, Wiegerinck JI, van Dijk CN. Treatment of midportion Achilles tendinopathy: an evidence-based overview. Knee Surg Sports Traumatol Arthrosc. 2016;24(7):2103-2111.

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