Achilles Tendonitis & Achilles Pain

The largest tendon in the body, the Achilles tendon, connects the calf muscles to the heel bones. Injuries to the Achilles tendon have skyrocketed in the United States. Whether you're starting a new exercise program or experiencing heel pain, knowing the signs of Achilles damage and tendon injuries when to seek medical attention are important.

What Is Your Achilles Tendon?

The Achilles tendon is the biggest tendon in the human body. It connects the calf to the foot, and it is responsible for push-off power. The tendon is critical for stability during standing, walking, running and other activities. During muscle contraction, the tendon functions as a rope. It has elasticity to generate the tension required to handle the force of six times a person’s body weight.

On a day-to-day basis, people put stress on their Achilles tendon. A healthy tendon will handle this stress, repair any “microtears,” and a patient will have no symptoms. But over time, for various reasons, the Achilles tendon will develop inflammation and microtearing that will outpace the body’s ability to repair and heal the damage, and you may develop symptoms including pain in the back of the heel, discomfort, soreness, swelling and limited range of motion in the ankle.

What Is Achilles Tendonitis?

Achilles tendonitis happens when the Achilles tendon becomes irritated and inflamed. The sheath of the Achilles becomes inflamed, often through overuse. People experiencing Achilles tendonitis may feel tenderness or swelling along the tendon with episodes of significant pain and stiffness.

“Not long ago, I couldn’t walk, and then I developed an egg-size knot just above my right heel,” said Francis Reed, a Richton Park, Illinois resident, who was dealing with a recurring left foot callous when Achilles tendonitis surfaced. “I didn’t know what was going on. But as soon as I showed it to Dr. Narcisi, he told me it was Achilles tendonitis.”

Achilles tendinitis is the accumulation of degenerative changes in the tendon, especially in chronic cases, caused by disorganized repair of areas of tendon damage that have accumulated gradually over time. The tendon will become thickened and lose its normal elasticity in many cases.

“Something as simple sounding as a callous can be life-altering for people who can't get up for their normal activities,” said Frank L. Narcisi, Jr, DPM, an independent physician who chooses to practice at Franciscan Health Podiatry Olympia Fields.

What Causes Achilles Tendonitis?

The American Academy of Orthopedic Surgeons says specific causes of Achilles tendonitis include:

Sudden increase in the amount or intensity of exercise

Sports with repetitive stopping and starting, like tennis, running, basketball and dance can increase the risk of Achilles tendon pain. Swimmers rarely develop Achilles tendinitis, because there is less tension on the Achilles tendon.

Tight or weak calf muscles

Tightness and weakness of the calf muscle is another major risk factor for Achilles tendon pain.

Tight calf muscles can put extra stress on the Achilles tendon. A calf muscle that is tighter leads to more tension and stress on the Achilles tendon. Over time, this tension can lead to the microdamage that is tendinitis. Having a weaker muscle also increases this damage. Think of the Achilles tendon and calf muscle as one unit. The stronger the muscle is, the more it protects the tendon. The weaker it is, the more work the muscle puts on the tendon.

Bone spurs

Bone spurs are extra growths of bone where the Achilles tendon attaches to the heel. Bone spurs can rub against the tendon and cause pain.

Being overweight

Overweight patients are more likely to develop Achilles tendinitis than someone of normal weight. Increasing body weight by just one pound increases the force on the Achilles tendon by six pounds.

What Are Symptoms Of Achilles Tendonitis?

According to the American Academy of Orthopaedic Surgeons, common symptoms of Achilles tendonitis include:

• Pain and stiffness along the Achilles tendon in the morning
• Pain along the tendon or back of the heel that worsens with activity
• Severe pain the day after exercising
• Thickening of the tendon
• Bone spur (insertional tendinitis)
• Swelling that is present all the time and gets worse throughout the day with activity
• Redness at the back of the heel

A "pop" is not a symptom of Achilles tendonitis. If you have experienced a sudden "pop" in the back of your calf or heel, you may have ruptured (torn) your Achilles tendon. See your doctor immediately if you think you may have torn your tendon.

How Is Achilles Tendonitis Treated?

Initial treatment for Achilles pain usually involves rest. That means if the tendon is really hurting after tennis five times a week, stopping tennis for a bit and resting completely is usually a good idea. Occasionally, a person can remain active, but avoid the higher impact sports — for example, do more biking or swimming and less tennis.

Other early treatment options for Achilles pain include ice on the affected area and ibuprofen or other non-steroidal anti-inflammatory medication.

Your doctor may also prescribe nonsurgical treatments like physical therapy, cortisone injections or immobilization in a cast or boot.

In most cases, Achilles tendonitis can be treated without surgery, although it may take a few months for symptoms to completely subside. Even with early treatment, the tendon pain may last longer than 3 months. If you have had pain for several months before seeking treatment, it may take 6 months before treatment methods take effect.

A conservative treatment plan including elevation, ice, physical therapy and inflammatory medication was prescribed for Francis. “Once I started physical therapy, they worked the foot and gave me exercises to do at home, it started to feel better, and I was able to walk,” Francis said.

“When you have a chronic problem like this, it's easy to get down about it, to resist treatment,” Dr. Narcisi said. “But Francis is always ready to tackle this problem, follow directions, and do her therapies and that’s the ideal person to treat.”

Dr. Narcisi cautions that chronic issues often resist conservative treatment options despite the best efforts of the doctor and patient.

“It’s very common for Achilles tendonitis to respond to conservative treatment and then flare up later,” Dr. Narcisi said. “Ultimately, we must be open to whatever will work best, including surgery.”

Can I Return To Exercise After My Achilles Pain Is Better?

While Achilles tendinitis is a painful condition that can make it hard to walk or exercise, a return to exercise is possible.

After the initial pain and swelling has decreased, exercise is the key treatment. This does not mean just get right back to how you exercised before you experienced heel pain or Achilles tendonitis. Instead, it means stretching the calf and doing a specific type of exercise called eccentric calf strengthening. Eccentric exercises means strengthening the muscle while it is lengthening. Being able to do these exercises properly, so it works the calf muscle and does not aggravate the tendon, can be tricky. Often a physical therapist is your best bet to guide you on proper technique and load.

The best stretches for Achilles tendonitis are calf stretches in a way that the knee is straight and the stretch is felt closer to the knee is ideal. Stretching off the wall or stairs works well. It is also recommended to stretch the hips, lower back and hamstrings. 

Can Achilles Tendonitis Be Prevented?

Some experts say stretching can prevent Achilles tendon injuries, but that's a controversial opinion. The best prevention is regular exercise and strength training catered to the individual. There are very few studies that have investigated the effects of specific prevention strategies.

HealthDay News contributed information to this article.