Many people experience heel pain that is caused by problems with the Achilles tendon. The pain can be mild or severe, but in all cases it hinders daily activities and creates stress. Here we will take a look at the conditions that lead to pain in the Achilles tendon, how they are caused, their symptoms and the way they need to be treated.
The Achilles tendon
The tendons are fibrous tissues that connect muscle to bone. The Achilles tendon is the largest tendon in the body, it runs down the back of the lower leg and connects your calf muscles to the heel bone. It helps you extend your foot; raise it when you are walking or running, rise up on your toes. This tendon can endure much pressure but it is unfortunately prone to tendonitis.
Common Achilles tendon disorders
Here we will explain the nature of the most usual conditions associated with the Achilles tendon and give advice on how to deal with them.
- Achilles tendinopathy
- Tendonitis (tendinitis)
Tendinitis is a condition which is not typically related to a tendon injury. It develops due to either overuse of the tendon (mostly in younger people) or as a result of arthritis (mostly in elderly people) and involves inflammation. If we take into consideration which part of the tendon has been inflamed, there are two types of Achilles tendonitis. Here they are:
Noninsertional Achilles Tendinitis
In this type of tendinitis, the middle part of the tendon is affected. It starts degenerating and swelling. This type usually affects younger and more physically active people.
Insertional Achilles Tendinitis
In this type of tendinitis, the lower portion of the Achilles tendon is affected (where the tendon attaches itself to the heel bone). This type can occur at any given time and is even found in people who are not doing any sports. With insertional Achilles tendinitis, there is a high chance that bone spurs may form, and in both types of tendinitis the damaged tendon fibers may harden.
If inflammation from Achilles tendonitis is not dealt with, it may progress to a degeneration of the tendon. This is called Achilles tendinosis – a condition in which the Achilles tendon’s structure is likely to lose its entirety and develop tiny tears in its structure.
- Tendon tear/rupture
An Achilles tendon can become partially or completely torn. With partial tear there may be no symptoms, but if we are talking about a complete rupture of the tendon, there will be pain and sudden loss of mobility.
Causes of Achilles tendonitis and tendinosis
&emps;Problems with the Achilles tendon do not happen suddenly. Most of the times, they are the result of putting too much stress on the tendon over time. Tiny tears develop on the surface of the tendon. Here are some of the causes of Achilles tendonitis and tendinosis and the conditions that increase the chances of developing it:
- A bone spur – if there is extra bone growth present, the tendon may become irritated
- Training aggressively or suddenly changing your training routine without letting your body adjust to the change, especially if your calf muscles are tight
- You jump a lot or run too often and you do it on hard surfaces such as concrete
- You have a flat foot arch and do not wear proper shoes
- You are a “weekend warrior” – a person who is physically active only on weekends
Causes of a tendon injury
The cause is, most of the times, a sudden movement with big force that put the calf muscle under too much pressure. It is a typical injury for middle-aged people and usually happens during an intense workout but keep in mind that it can also happen during normal walking or running.
Symptoms of Achilles tendonitis and tendinosis
The symptoms of Achilles tendonitis and tendinosis include the following:
- Pain and stiffness along the tendon – in the morning; when walking/running; on the day after exercising
- Swelling that continuously gets worse
- Bone spur (if we are talking about insertional tendonitis)
- Enlargement of the tendon when the disorder progresses to degeneration
Symptoms of a tendon injury
- Pain – with tendonitis, pain could be moderate and gradually worsen, but if you rupture your tendon, pain will most likely be sudden and sharp.
- A “pop” noise indicates a rupture
- Not being able to flex your foot
- Swelling, bruising, etc.
Treatment of Achilles tendon conditions
Treatment depends on the severity of the condition. In the majority of cases, the pain will last for some months as the tendon needs time to repair itself, so you need to be patient and rest. Surgery has to be considered only if the pain lasts for too long (half a year despite nonsurgical treatment). Let us take a look at the usual types of nonsurgical treatment and some forms of surgical treatment. Nonsurgical treatment:
- Ice – helps relieve pain and reduce swelling. Wrap the ice in something first and then place it on the tendon. You could ice the spot for about twenty minutes to half an hour every three to four hours.
- Rest and foot elevation – if you have ruptured your tendon, it is of high importance to avoid putting weight on your leg as much as you can. Use a pillow to elevate it when you are lying down and crutches to move around. If you suffer from tendonitis, make sure to decrease or even stop the activities that have led to its development.
- Medicine – usually, doctors prescribe nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen and ibuprofen, to help you deal with pain and swelling. However, they have side effects (such as every medicine), so use them carefully and always contact a specialist if you have doubts.
- Physical therapy – said to be of more help to noninsertional tendinitis than for insertional tendinitis.
- Exercise – stretching and strengthening exercises are recommended to make the tendon flexible again and reduce stress on it, help it get back to normal.
- Supportive shoes and orthotics – pain can be reduced by wearing special shoes or orthotic devices, for example shoes with soft paddings on the parts that touch the tendon; putting a heel lift inside your shoes.
A torn or ruptured tendon sometimes requires surgery or at least using some form of a device such as a cast or brace to keep the leg immobile. Surgical treatment
- Gastrocnemius recession – surgical lengthening of the calf muscles
- Débridement and repair (less than 50% damage) – removing the damaged part of the tendon
- Débridement with tendon transfer (more than 50% damage) – in this procedure, the surgeons put the tendon that points the big toe down to the heel bone in order to make the damaged tendon stronger and more flexible.
You should know that treatment for Achilles tendon problems takes time and there is always a small chance that you will not be able to participate in sports as much as before. However, most people respond well to treatment and do not need to undergo surgery, just rest, take their medication and make sure to avoid stress as much as possible. To reduce the risk of getting tendonitis, make sure to do exercises that will keep your calf muscles strong and flexible but do not overuse them because it will have the opposite effect of what you are trying to achieve.