Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Achilles Tendinopathy

(Achilles Tendonitis; Achilles Tendinosis)
by Carrie Myers Smith, BS
Definition

Tendinopathy is an injury to the tendon. It can cause pain, swelling, and limit movement. The injuries can include:

  • Tendinosis—microtears (tiny breaks) in the tendon tissue with no significant inflammation
  • Tendonitis—an inflammation of the tendon (Although this term is used often, most cases of tendinopathy are not associated with significant inflammation.)

The Achilles tendon connects the calf muscles to the heel bone. Tendinopathy and the associated pain may take months to resolve.

Causes

Tendinopathy is generally caused by overuse of a muscle-tendon unit. Over time, the strain on the tendon causes structural changes within the tendon itself.

Overuse of the Achilles tendon is more common when:

  • A sudden or violent contraction of the calf muscles, such as during an all-out sprint
  • Doing too much too soon after taking time away from exercising
  • Increasing your speed or running long distances too quickly
  • Lack of flexibility of the calf muscles
  • Running too much (overuse)
  • Suddenly adding strenuous hills or stair climbing to your exercise routine
Risk Factors

Factors that increase your chance of Achilles tendinopathy include:

  • An improper training program
  • Improper cool-down
  • Improper or badly worn footwear
  • Improper warm-up for your activity
  • Inflexibility of the calf muscles
Symptoms

Symptoms may include:

  • Pain after activity that gradually worsens
  • Pain at the back of the ankle
  • Radiating or localized pain along the tendon during and/or after running
  • Stiffness that gradually eases as the tendon is warmed-up
  • Swelling in the area of the Achilles
  • Tenderness—usually located 1-2 inches above the point where the tendon attaches to the heel bone (noticeable in the morning upon rising)
Diagnosis

The doctor will ask about your symptoms and exercise habits. A physical exam will be done.

Your doctor will likely make a diagnosis based on the exam and history. If the symptoms and signs are unclear your doctor may order:

  • MRI scan —to view areas of interior damage to the tendon
  • X-rays —to see if there is calcium in the tendon
Treatment
Rest

Take a break from the activity that caused the tendinopathy. Switch to an activity that doesn't put stress on the tendon. Avoid uphill and irregular surfaces. Swimming is a good option.

Gradually increase your activity levels. Ice the area for 20 minutes if you have activity related pain.

Orthotics

You may be advised to wear a shoe insert. It will place your foot in the correct position for walking and running.

Physical Therapy
Medications

Some people may benefit from nonsteroidal anti-inflammatory agents (NSAIDs). They may be helpful in relieving the pain and decreasing inflammation. This is not curative. It must be combined with other treatment. Topical pain medicines (eg, creams, patches) applied to the skin are another option.

If you are diagnosed with this condition, follow your doctor's instructions .

Prevention

To decrease your chances of getting Achilles tendonitis:

  • Do not use shoes beyond the recommended duration. This will depend on:
    • How frequently you exercise
    • The conditions in which you exercise
    • The surface on which you exercise
  • Gradually add hill work, stairs, speed, and distance to your routine.
  • Stretch and strengthen the calf muscles regularly.
  • Take the time to warm-up and cool-down properly.
  • Wear appropriate footwear for your sport.

Last reviewed: September 2011 by Lawrence Frisch, MD, MPH.

RESOURCES:
CANADIAN RESOURCES:
References:
  • Achilles tendinopathy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated June 2009. Accessed July 9, 2009.
  • American Academy of Orthopaedic Surgeons website. Available at: http://www.aaos.org/ . Accessed July 9, 2009.
  • de Jonge S, van den Berg C, de Vos RJ, et al. Incidence of midportion Achilles tendinopathy in the general population. Br J Sports Med. 2011;45(13):1026-1028.
  • Irwin TA. Current concepts review: insertional achilles tendinopathy. Foot Ankle Int. 2010;31(10):933-939.
  • Mayo Clinic Health Letter website. Available at: http://healthletter.mayoclinic.com/ . Accessed July 9, 2009.
  • 10/26/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Massey T, Derry S, Moore R, McQuay H. Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev. 2010;(6):CD007402.