Achilles tendinitis

Achilles tendinitis is an injury of the Achilles (uh-KILL-eez) tendon. It can be caused by using it too much or too hard without enough rest, called overuse. Or it can develop without a clear cause. The Achilles tendon is the band of tissue that joins calf muscles at the back of the lower leg to the heel bone.

Achilles tendinitis also is called Achilles tendinopathy. It often occurs in runners who have suddenly increased how hard or long they run. It's also common in middle-aged people who play sports, such as tennis or basketball, only on the weekends.

Most often, Achilles tendinitis can be treated with at-home care guided by a healthcare professional. Self-care steps can be helpful to prevent Achilles tendinitis from returning.

Serious cases of Achilles tendinitis can lead to tendon tears, also called ruptures. Tears might need surgery to fix them.

Achilles tendinitis pain most often begins as a mild ache in the back of the leg or above the heel after running or other sports activity. More-severe burning or aching pain might occur after running a long time, stair climbing or sprinting. Over time, there might be pain even at rest.

Achilles tendinitis can make it hard to use the affected foot. The area also might be tender or stiff, especially in the morning. The soreness usually gets better with mild activity.

If you have pain around the Achilles tendon that doesn't go away, call your healthcare professional. If the pain is suddenly severe or keeps you from moving, you may have torn your Achilles tendon. Seek medical help right away.

Repeated or intense strain on the Achilles tendon can cause Achilles tendinitis, though sometimes the cause is not clear. The Achilles tendon is the band of tissue that joins the calf muscles to the heel bone. This tendon is used while walking, running, jumping, climbing or standing on tip toes. Achilles tendinitis can occur within the middle part of the tendon or where it attaches to the heel bone.

The Achilles tendon weakens with age. That can make it easier to injure. This is true for people who play sports only on the weekends or who start running farther, faster or longer without building up over time.

Factors that can raise the risk of Achilles tendinitis include:

• Age. Achilles tendinitis is more common with age.
• Physical problems. A flat arch in the foot or a high arch can increase strain in the Achilles tendon. Obesity and tight calf muscles also can increase tendon stress. Having legs that are different lengths also can increase the risk.
• Having had Achilles tendinitis. This increases the risk of getting it again.
• Training choices. Running in worn-out shoes can increase the risk of Achilles tendinitis. So can running with poor form. Tendon pain occurs more often in cold weather than in warm weather. Running hills also can raise the risk of Achilles injury.
• Medical conditions. People who have the skin condition called psoriasis, high cholesterol or high blood pressure are at higher risk of getting Achilles tendinitis.
• Medicines. Certain types of antibiotics, called fluoroquinolones, have been linked with higher rates of Achilles tendinitis.

Achilles tendinitis can weaken the tendon. The weakness makes it more likely to tear, also called rupture. An Achilles rupture is a serious injury that often needs surgery to repair it.

It may not be possible to prevent Achilles tendinitis. But here are some ways to reduce the risk:

• Increase your activity level slowly. If you're just starting a new exercise, start slowly. Increase how long and hard you train little by little.
• Take it easy. Do not do activities that put a lot of stress on your tendons, such as hill running, if you're not used to them. If you do a hard activity, warm up first by exercising at a slower pace. If you notice pain during an exercise, stop and rest.
• Choose your shoes well. The shoes you wear for exercise should cushion your heel. They should have a firm arch support to help reduce the tension in the Achilles tendon. Replace worn-out shoes. If your shoes are in good shape but don't support your feet, try arch supports in both shoes.
• Stretch daily. Take the time to stretch your calf muscles and Achilles tendon in the morning and before and after exercise. This is to keep the tendon flexible. It also can keep Achilles tendinitis from happening again.
• Strengthen your calf muscles. Strong calf muscles help the calf and Achilles tendon handle the stresses of exercise.
• Cross-train. Do not do high-impact activities, such as running and jumping, every day. On off-days, do low-impact activities, such as cycling and swimming.

During the physical exam, your healthcare professional will press gently on the area to find where the pain, tenderness or swelling are and watch how the foot and ankle look moving and at rest.

Imaging tests

One or more of these tests can help diagnose Achilles tendinitis:

• X-rays. X-rays do not show soft tissues such as tendons. But they may show some signs of Achilles tendinitis and can help rule out other conditions that can cause some of the same symptoms.
• Ultrasound. This device uses sound waves to look at soft tissues such as tendons. Ultrasound also can make real-time images of the Achilles tendon to show how it moves. And color-Doppler ultrasound can look at blood flow around the tendon.
• MRI. Using radio waves and a strong magnet, MRI scans can show the Achilles tendon in detail.

Tendinitis most often does well with self-care. But if your symptoms are severe or long-lasting, other treatments to try might include the following.

Medicines

Pain medicines you can get without a prescription might help. These include ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve). If these don't help enough, you might get a prescription for medicines to reduce swelling and irritation, called inflammation, and relieve pain.

One prescription option is a nitroglycerin patch. You put the patch on the tendon to help with healing and pain relief. You might need to put the patch on the sore part of the tendon every day for 2 to 3 months.

Physical therapy

A physical therapist might suggest the following:

• Exercise. A therapist might prescribe exercises designed to heal and strengthen the Achilles tendon. Resistance exercises using heavy loads, such as weighted heel raises, might be especially helpful for ongoing, called chronic, Achilles tendinitis.
• Orthotic devices. A shoe insert or wedge that slightly raises your heel can relieve strain on the tendon. For some tendon pain, a heel pad can cushion the sore area.

Newer therapies

These therapies have been used for Achilles tendinitis with some success:

• Extracorporeal shock wave therapy (ESWT). This treatment doesn't require cutting into the body, called noninvasive. It sends shock waves to injured tissue to relieve pain and help with healing. It often is used when self-care measures haven't worked but before deciding on surgery.

  Treatment involves having a series of sessions that each last 30 minutes or less. Side effects usually are mild. They might include bruising, swelling, pain, numbness or tingling in the treated area.

• Platelet-rich plasma. This treatment, given as shots, uses a person's own platelets. Platelets are cells in the that form clots to stop bleeding and start healing. PRP has growth factors that may help the body heal.

• Ultrasound-guided tenotomy. This treatment uses a special device to break up damaged parts of the tendon and remove unhealthy tissue. The procedure is done through a small cut. Ultrasound guides the device.

  The procedure gets the tendon to start healing. For the first few weeks, you'll need crutches and a walking boot. It usually takes several months for the tendon to fully heal.

• Ultrasound-guided tendon scraping. In tendinopathy, tiny nerves and vessels grow into the tendon that may cause pain. Tendon scraping is a procedure done through a small cut. Ultrasound guides the device.

  The device scrapes the surface of the tendon. It disconnects the unusual nerves and vessels. This can give quick pain relief and a return to activities within a week.

Surgery

If several months of more-conservative treatments don't work or if the tendon has torn, you might need traditional surgery to repair your Achilles tendon.

Self-care includes the following, often known as R.I.C.E.:

• Rest. You may need to not exercise for several days. Or you can do activities that don't strain the Achilles tendon, such as swimming or deep-water running. For severe Achilles tendinitis, you might need to wear a walking boot and use crutches.
• Ice. To lessen pain or swelling, apply an ice pack to the tendon for about 15 minutes after exercising or when you feel pain.
• Compression. Wraps or elastic bandages that hold in the affected area can help reduce swelling and keep the tendon from moving much.
• Elevation. Raise the affected foot above the level of your heart to reduce swelling. Sleep with your affected foot raised at night.

You'll likely first contact your family healthcare professional. You might be sent to a doctor specializing in sports medicine or physical and rehabilitative medicine, called a physiatrist. If your Achilles tendon has torn, you may need to see an orthopedic surgeon.

What you can do

Before your appointment, you may want to write a list of answers to the following questions:

• Did the pain begin suddenly or come on little by little?
• Are symptoms worse at certain times of day or after certain activities?
• What shoes do you wear during exercise?
• What medicines and supplements do you take regularly?

What to expect from your doctor

A member of your healthcare team might ask you:

• Where exactly does it hurt?
• Does the pain get better with rest?
• What is your usual exercise routine?
• Have you recently made changes to your exercise routine, or have you recently started a new sport?
• What have you done for pain relief?