A condition that often results in serious heel pain is known as Achilles tendonitis. This condition may form when the Achilles tendon is damaged as a result of overuse. This particular injury can be very serious, as the Achilles tendon’s main function is to connect the lower half of the calf muscles to the heel bone. If this tendon becomes damaged, it may result in difficulty walking and completing everyday tasks, as well as cause extreme discomfort and pain.

It’s more common for athletes to experience Achilles tendon injuries, as they’re more likely to be participating in activities that would call for repetitive movement, such as running or jogging. This kind of repetitive movement over time is likely to cause stress on the tendon. When athletes abruptly increase their performance level without properly training or warming up their bodies, they may also injure the Achilles tendon, which may lead to inflexibility in the calf muscles.

In order to prevent this kind of injury, it’s suggested to perform stretches—particularly focused on the calf region—about one to three times a day to keep the area flexible. Focusing on building strength in your calves is also advised. If you believe you’ve injured your Achilles tendon, there are some actions you can take to help alleviate the discomfort. Icing and massaging the affected area may help to calm the pain, as well as practicing light stretches. 

If you’re having difficulty walking or icing the area does not alleviate the pain, it’s highly advised that you speak with a podiatrist for professional care and an advised treatment plan.

Achilles Tendon Disorders Q & A

What are Achilles Tendonitis and Achilles Tendonosis?

Two common disorders that occur in the heel cord are Achilles tendonitis and Achilles tendonosis. Achilles tendonitis is an inflammation of the Achilles tendon. This inflammation is typically short-lived. Over time the condition usually progresses to a degeneration of the tendon (Achilles tendonosis), in which the tendon loses its organized structure and is likely to develop microscopic tears. Sometimes the degeneration involves the site where the Achilles tendon attaches to the heel bone. In rare cases, chronic degeneration with or without pain may result in rupture of the tendon.

What are the symptoms?

The symptoms associated with Achilles tendonitis and tendonosis include:

• Pain—aching, stiffness, soreness, or tenderness—within the tendon. This may occur anywhere along the tendon’s path, beginning with the narrow area directly above the heel upward to the region just below the calf muscle. Often pain appears upon arising in the morning or after periods of rest, then improves somewhat with motion but later worsens with increased activity.
• Tenderness, or sometimes intense pain, when the sides of the tendon are squeezed. There is less tenderness, however, when pressing directly on the back of the tendon.
• When the disorder progresses to degeneration, the tendon may become enlarged and may develop nodules in the area where the tissue is damaged.

What are the causes?

As “overuse” disorders, Achilles tendonitis and tendonosis are usually caused by a sudden increase of a repetitive activity involving the Achilles tendon. Such activity puts too much stress on the tendon too quickly, leading to micro-injury of the tendon fibers. Due to this ongoing stress on the tendon, the body is unable to repair the injured tissue. The structure of the tendon is then altered, resulting in continued pain. Athletes are at high risk for developing disorders of the Achilles tendon. Achilles tendonitis and tendonosis are also common in individuals whose work puts stress on their ankles and feet, such as laborers, as well as in “weekend warriors”—those who are less conditioned and participate in athletics only on weekends or infrequently.

In addition, people with excessive pronation (flattening of the arch) have a tendency to develop Achilles tendonitis and tendonosis due to the greater demands placed on the tendon when walking. If these individuals wear shoes without adequate stability, their over-pronation could further aggravate the Achilles tendon.

How do you diagnose Achilles Tendonitis or Tendenosis?

In diagnosing Achilles tendonitis or tendonosis, the surgeon will examine the patient’s foot and ankle and evaluate the range of motion and condition of the tendon. The extent of the condition can be further assessed with x-rays, ultrasound, or MRI.

What are the treatment options for Achilles Tendonitis and Achilles Tendonosis?

Treatment approaches for Achilles tendonitis or tendonosis are selected on the basis of how long the injury has been present and the degree of damage to the tendon. In the early stage, when there is sudden (acute) inflammation, one or more of the following options may be recommended:

• Immobilization. Immobilization may involve the use of a cast or removable walking boot to reduce forces through the Achilles tendon and promote healing.
• Ice. To reduce swelling due to inflammation, apply a bag of ice over a thin towel to the affected area for 20 minutes of each waking hour. Do not put ice directly against the skin.
• Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be helpful in reducing the pain and inflammation in the early stage of the condition.
• Physical therapy. Physical therapy may include strengthening exercises, soft-tissue massage/mobilization, gait and running re-education, stretching, and ultrasound therapy.

If non-surgical approaches fail to restore the tendon to its normal condition, surgery may be necessary. The foot and ankle surgeon will select the best procedure to repair the tendon.

How do you prevent Achilles Tendonitis and Achilles Tendonosis?

To prevent Achilles tendonitis or tendonosis from recurring after surgical or non-surgical treatment, the foot and ankle surgeon may recommend strengthening and stretching of the calf muscles through daily exercises. Wearing proper shoes for the foot type and activity is also important in preventing recurrence of the condition.