Heel Pain - Achilles Tendonitis

What is Achilles Tendinitis?

Achilles tendinitis is a fairly common condition that causes pain along the back of the leg near the heel.

The Achilles tendon is the largest tendon in the body. It is named after the Greek mythological hero Achilles, who was killed by an arrow aimed at his only vulnerable site on his body- the heel cord. The tendon is a cord like structure which connects your calf muscles to your heel bone and is used when you walk, run, and jump. It is prone to tendinitis, a condition associated with overuse and degeneration.Tendinitis is inflammation of a tendon. Inflammation is the body's natural response to injury or disease, and often causes swelling, pain, or irritation.

There are two types of Achilles tendinitis, based upon which part of the tendon is inflamed.

Noninsertional Achilles Tendinitis

Tendinitis of the middle portion of the tendon more commonly affects younger, active people.

Insertional Achilles Tendinitis

Insertional Achilles tendinitis involves the lower portion of the heel, where the tendon attaches (inserts) to the heel bone. Tendinitis that affects the insertion of the tendon can occur at any time, even in patients who are not active.

Achilles tendinitis usually results from repetitive stress to the tendon. This happens when we push our bodies to do too much, too soon, but other factors can make it more likely to develop tendinitis, including:

 

  • Sudden increase in the amount or intensity of exercise activity

  • Tight calf muscles—Having tight calf muscles and suddenly starting an aggressive exercise program can put extra stress on the Achilles tendon

  • Bone spur—Extra bone growth where the Achilles tendon attaches to the heel bone can rub against the tendon and cause pain

What are the symptoms of Achilles tendinitis?

 

Common symptoms of Achilles tendinitis 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 tendonBone spur (insertional tendinitis)

  • Swelling round the ankle, especially so at the back.

What are the treatment options?

Nonsurgical Treatment

The surgeon may want to get further information with investigations such as an ultrasound scan or an MRI scan. In the initial stages non surgical measures can be tried, such as rest, analgesics & anti-inflammatories, Calf stretching and Isometric exercises under guidance of a physiotherapist and supportive shoes, heel supports and orthotics. Ultrasound therapy and Shock-wave therapy can also be tried.

Surgical Treatment

This is needed only if the pain and symptoms do not subside inspite of non-surgical measures for a few months.The type of surgery depends on the type of tendonitis and its severity.The various options are:

  • Calf muscle lengthening

  • Radio-frequency ablation to aid healing.

  • Removal of the diseased portion of the tendon and repair.

  • Removal of the diseased portion and transfer of tendon to support the damaged tendon.

 

Recovery.

Most patients have good results from surgery. The main factor in surgical recovery is the amount of damage to the tendon. The greater the amount of tendon involved, the longer the recovery period, and the less likely a patient will be able to return to sports activity.Physical therapy is an important part of recovery.Please discuss the risks of surgery with the surgeon.

 

These treatments are provided by Sports Surgeon Cochin at Aster Medcity.

 

 

Dr Vinod Kumar Abu Dhabi

Sports surgeon Abu Dhabi

Shoulder surgeon Abu Dhabi

NMC Royal Hospital