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Achilles Tendinitis Treatment Options (Surgical and Conservative)

Achilles Tendinitis Treatment

Achilles tendinitis is the inflammation of Achilles tendon. Achilles tendon is considered the strongest tendon in the body, which connects the back of the leg to the heel bone. Achilles tendinitis is a common injury, which tends to occur in middle-age recreational athletes (weekend warriors). Overuse of Achilles tendon causes inflammation, which leads to pain and swelling, which at times it can be debilitating. It should not be confused with Achilles tendinosis, which is the result of chronic inflammation, scarring and microscopic degenerative changes (tears) within the tendon substance.

Usually, Achilles tendonitis is divided into 2 categories:

  • Insertional tendinitis: Where the tendon inserts into the back of the heel becomes inflamed and usually is associated with a bump / swelling to the back of the heel. Usually, bone spur can develop to the back of the heel.
  • Non-insertional tendinitis: Mid-portion of the tendon becomes inflamed and is tender on palpation. If chronic, a palpable lump may be noted on palpation

 

What are Some Causes of Achilles Tendinitis:

  • Tightness of Achilles tendon (Equinus)
  • Flat Foot / Overpronation (Pes Planus)
  • High arch foot (Pes Cavus)
  • Shoe gear irritation
  • Not stretching before sports activity
  • Direct trauma
  • Some medications such as Fluoroquinolones are know to cause Achilles tendon pathology.

 

What are Some Symptoms of Achilles Tendinitis:

  • Pain to the back of the heel with ambulation, especially after sitting for a period of time. Usually, the first few steps out of the bed in the morning may be painful.
  • Pain / soreness on palpation of Achilles tendon (usually 2-4 cm above where the tendon attaches to the back of the heel. This area is called the “watershed” portion of Achilles tendon and is know to have poor blood supply and is particularly susceptible to inflammation, scarring and possible rupture)
  • Pain to the back of the heel or to Achilles tendon with range of motion of the ankle joint (Dorsiflexion / Plantarflexion)
  • Pain with pushing off or jumping during exercise.
  • Pain to Achilles tendon going up stairs / hills

 

Imaging for Achilles Tendinitis:

  • X-ray: Usually does not show anything unless there is a bone spur to the back of the heel
  • MRI: May be needed to evaluate for a possible tear within the tendon. A MRI may also be helpful for preoperative planning.

 

Achilles Tendinitis Treatment (Conservative):

(Depending on the length of your symptoms, it can take between 3-6 months for treatment to take effect)

  • Immobilization – allow the tendon to heal itself. (Walking boot for 6 weeks. Prolong use of walking boot can lead to weakening of the calf muscle)
  • Ice
  • Stretching exercises targeting Achilles tendon (Click here)
  • Non-steroidal Anti-inflammatory medication (NSAID)
  • Heel lifts – to decrease tension on achilles tendon and allowing it to heal
  • Night splint – to stretch the Achilles tendon
  • Orthotics / Inserts
  • Supportive shoes
  • Physical Therapy
  • Topical pain relieving gel

***Cortisone injection is not recommended for Achilles tendinitis, as it can weaken the tendon, leading to Achilles tendon tear / rupture.

Achilles Tendinitis Treatment (Surgical):

Surgical intervention is recommended only if patient has failed conservative treatment options. The specific type of surgical intervention depends on the location of tendonitis and the amount of damage to the tendon.

Achilles Tendinitis Images:

 

Achilles Tendinitis Treatment
Typical Area of Achilles Tendinitis
Achilles Tendinitis Treament
Typical Area of Achilles Tendinitis

Achilles Equinus (Tight Achilles Tendon)

 

Achilles Equinus (Tight Achilles Tendon) Overview

Achilles equinus or “tight achilles tendon” is a condition in which the upward bending of the ankle joint is limited. Someone with equinus lacks the flexibility and can occur in one or both feet.  People with equinus develop ways to “compensate” for their limited ankle motion. Individuals can compensate by picking up the heel early when walking (early heel off) leading to “toe walking”, picking up the heel early when walking, and this often leads to other foot, leg, or back problems.

 

Causes of Achilles Equinus (Tight Achilles Tendon):

  • Tightness of gastrocnemius muscle (calf muscle)
  • Tightness of soleus muscle
  • Congenital (present at birth)
  • Long cast immobilization
  • Use of crutches
  • Wearing high heel shoes
  • Lack of stretching exercises
  • Neurological (spastic) disorder

 

Foot Problems Related to Achilles Equinus:

  • Plantar fasciitis (arch/heel pain)
  • Calf cramping
  • Achilles Tendonitis
  • Metatarsalgia (pain on the ball of the foot)
  • Callus formation on the ball of the foot
  • Flatfoot deformity
  • Midfoot arthritis
  • Ulcer (pressure sore) to the ball of the foot
  • Bunions
  • Hammertoes
  • Shin Splints

 

Diagnosis of Achilles Equinus:

To diagnose equinus, the foot and ankle surgeon will evaluate the ankle’s range of motion when the knee is flexed (bent) as well as extended (straightened).  Less than 10 degrees of ankle dorsiflexion is considered tight Achilles tendon (equinus)

 

Non-Surgical Treatment of Achilles Equinus:

  • stretching exercises that lengthen Achilles tendon
  • Night Splints shopping cart
  • Physical therapy
  • Topical pain relieving gel shopping cart

 

When is Surgery Needed for a Symptomatic Tight Achilles Tendon?

In some cases, surgery such as Achilles tendon lengthening or gastrocnemius recession may be needed to correct the cause of equinus.