Achilles Tendinitis – Guide on Causes, Prevention & Rehabilitation

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There are many potential injuries that can arise as a consequence of running. These can be brought about through too high a level of activity, poor running form, inadequate muscle strength, or unforeseen genetic factors. Regardless of how they occur, these injuries can be debilitating and painful, costing you days or weeks of training and potential permanent disfiguring damage if untreated. Achilles tendinitis, also known as intersectional Achilles tendinopathy, is one such injury that can be brought about by running. This guide will discuss the nature of this condition, some of the potential causes of it, the diagnostic process, false positives, some methods of dealing with it as it arises, and ways to treat and prevent it.

Achilles Tendinitis

What is the Achilles Tendon?

There are a number of muscles, ligaments and tendons that make up the human foot. These are responsible for distributing the weight of the entire body evenly, promoting balance, and ensuring that movement is smooth and efficient. The tissue is a band of fibrous tissue located on the back of the ankle. Its purpose is to connect the heel bone, or calcaneus, to the calf muscles. It is named after Achilles, a warrior from Greek mythology that was said to be impervious to injury everywhere except on the back of his heel. The term “Achilles heel” is also derived from this ancient story, as it refers to a hidden weakness on an otherwise powerful figure.

It is responsible for movements required in order to run or jump, as it affects humans’ ability to stand on their toes. It is one of the largest and strongest tendons in the human body, but it is also very susceptible to injury. In addition, common afflictions to this part of the foot include tears, ruptures, and damage to the bursa, which is a connecting cushion behind the tendon. Maintaining the tissue is incredibly important to a serious runner, as it is a vital component in the running process.

What is Achilles Tendonitis?

Achilles tendinitis is when the Achilles tendon becomes inflamed. One of the major symptoms is pain in the tendon area, which increases with activity. Other symptoms are swelling, stiffness, and occasionally the appearance of bone spurs. Oftentimes,  it comes about as a result of degradation or overuse, and can lead to more serious damage if untreated.

Symptoms

  • Stiffness
  • Swelling
  • Pain, with or without activity
  • Bone spurs
  • Thickening of tendon
  • Limited range of motion

1264px-rupture_tendon_achileen

Insertional versus Noninsertional Achilles Tendonitis

Depending on which portion that is affected, there are different classifications of Achilles tendinitis. Noninsertional tendinitis refers to the upper portion of the tendon, closer to the calf than the heel. When this section becomes inflamed, it is usually due to unreasonably high activity, and most often afflicts younger people. Insertional tendinitis is when the lower portion of the tendon is affected: the portion that inserts (hence the title) into the heel bone. Unlike the noninsertional variety of this ailment, Insertional tendinopathy affects people of all ages, and isn’t necessarily related to high activity.

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Causes

Depending on the type of Achilles tendonitis, there are different potential causes for the ailment to occur. Some cases are more likely to afflict people of different ages, and people who engage in different levels of activity. For the most part, Achilles tendonitis is caused by abuse or neglect of the foot, but it can also be caused by unfortunate genetic factors. Men are more likely to develop this injury than women, as are the overweight.

High activity

In many cases, the catalyst for the condition was an unreasonably high level of activity. This isn’t as likely to occur in younger people who work up to a high level of activity incrementally. However, even in these cases, the likelihood of this condition is still high, simply due to frequent repetitive motions causing deterioration over time.

Statistics on Incidence

  • It affects 7 out of 100,000 people on average
  • 10% of cases are from patients with previous conditions
  • Athletes are 24% likely to develop it
  • Of those, 18% are younger than 45 years old
  • Competitive runners are 40-50% likely to develop it
competitive-running
Wikimedia commons

Poor posture

As is the case with many running injuries, improper posture when standing or walking can play a major role in the development of Achilles tendinitis. As one study showed, changes in biomechanical functions of the lower leg, such as reduced flexion in the ankle and lower leg, can cause higher rates of to develop. This is why a common form of treatment and prevention of this injury is to analyze and correct posture.

Tight calf muscles

The upper part of the is connected to the soleus, also known as the calf muscle. Located below the thigh on the back of your leg, this muscle plays an instrumental role in the running process. As a result, it is prone to tightness if mistreated. When the calf muscles in your body get too tight, they limit your dorsiflexion, or the ability to bend your foot at the ankle. The limited range of motion caused by tight calves can contribute to the development of Achilles tendinitis over time.

Improper running equipment

Sometimes, the cause is more environmental than physical. If you wear running shoes that are too worn or too small, it’s more likely for tendinopathy to develop due to poor foot support. Additionally, running on harsh or uneven surfaces also contributes greatly to the likelihood of developing this ailment. In order to prevent Achilles tendonitis from occuring, make sure to wear proper footwear and to run on more accommodating surfaces.

Bone structure

Although rare, there have been instances where the skeletal structure of a person was the trigger. One such recorded instance was due to a man whose heel bone was tilted outward slightly. This caused pressure to be unevenly distributed among the calf and tendon, which is what eventually caused inflammation. Bone irregularities such as these can be caused by misuse, prior injury, or even unlucky genetics.

Age

As you age, the likelihood of development of this condition from exercise increases. Studies have shown that the tendons in older people tends to be tighter, and to have less blood flow. The Achilles tendon already has very little blood flow, so this can be a serious concern. These factors greatly increase the chance of developing tendinopathy, so older runners will need to take more precautions in order to prevent injury.

Wikimedia Commons
Wikimedia Commons

Antibiotics

Recent medical developments have revealed that in some cases, antibiotics treatment has led to Achilles tendinitis in some patients. In particular, fluoroquinolone antibiotics have been linked to the development of tendinopathy and, in some extreme cases, Achilles tendon rupture. Doctors have warned that taking antibiotics such as Cipro, Levaquin, or Noroxin can triple or even quadruple the risk of developing tendon damage.

Diagnosing Achilles Tendonitis and Insertional Tendinopathy

In the process of determining whether or not you have these condition, doctors may try a variety of methods. These are useful for determining the cause of any pain and ruling out any other ailments that could be false positives. Additionally, an accurate diagnosis will help determine whether it’s tendonitis or insertional tendinopathy you’re dealing with.

  1. Patient Interview: The doctor will ask a series of questions gauging the location of your pain, the level of severity, and the events leading up to it.
  2. Observation: In this phase, doctors will have you perform standing and flexing exercises. This will determine the effectiveness of the muscles: their flexibility and range of motion.
  3. Physical Examination: This involves touching the affected area to get more information on the exact location of the pain.
  4. Ultrasound: The usage of ultrasound technology has been highly effective for diagnosing foot problems; it is a noninvasive method of determining the state of tendons and inflammation.
  5. X-Rays: In the event that further examination is required, doctors may take x-rays of the surrounding area to get an image with more information.
  6. MRI: This is fairly rare, but a doctor may need to obtain even more information using an MRI machine.

False positives

One of the reasons for such a thorough diagnostic process is to determine that the ailment specifically affecting you is in fact Achilles tendinitis, and not one of the other numerous maladies that can affect the foot. These are some conditions with similar symptoms:

  • Tearing/Rupture: Also known as tendinosis, this is a more severe foot ailment and can come as a result of extended abuse of the foot. Untreated tendinitis can cause this, but it requires different treatment methods such as surgery.
  • Heel spurs: Caused by a buildup of calcium in the lower foot, this is very similar in look and sensation to the pain from insertional tendinopathy. While it may cause tendonitis if untreated, the treatment process is different.
  • Paratenonitis: This condition feels very similar to noninsertional  tendinopathy, as the pain is located in the same spot. However, it affects the paratenon, or the sheath surrounding the tissue.
  • Bursitis: The retrocalcaneal bursa is the cushion between the heel bone and tendon. When damaged, the pain felt is similar to insertional tendinopathy, but is much more serious.
  • Diabetes: Numbness or cramping in the area may be early signs of diabetes. This is a more severe ailment involving nerve damage, and requires an entirely different approach to treatment.
  • Fibromyalgia: This illness causes musculoskeletal pain, as well as fatigue and memory issues. Pain can be focused near the tissue, making this a false positive.
  • Multiple Sclerosis: This is a very serious disease that affects the central nervous system. It is especially difficult to diagnose, as it effects many parts of the body in ways that are similar to other injuries.
  • Arthritis: If the aches and pains felt in your foot are located in more locations on your body, and if it’s focused more on joints then on the ankle or heel, arthritis may be the cause. This is more common among older people.
Achilles-tendon-tear-surgery
Wikimedia-Commons

Treating Achilles Tendonitis

Once a doctor has correctly identified the cause of your pain as being Achilles tendonitis, proper treatment can begin. Treatment methods vary: some are better for treating noninstertional Achilles tendinopathy, while others are better for treating the insertional variety. Try some of these methods to aid in the recovery process.

  • Rest: This is the first step you should take. A period of rest will give your foot a better chance at recovering, and works in tandem with other methods listed below. This should be a given, but if you’re currently training and can’t afford the downtime, at least reduce the intensity of your workouts and take frequent breaks.
  • Ice/Heat: Using an ice pack or something similarly cold will help greatly in reducing inflammation. In other cases, heat packs are recommended for treating these conditions. A good idea is to try a combination of the two; alternating between heat and ice properly will go a long way toward recovery.
  • Orthotics: Specific orthotic devices are very useful in reducing the pain brought on by Achilles tendinitis, according to some podiatrists. In addition, they can mitigate the causes of its onset and preventing it from happening in the future. These orthotics are mainly insoles for shoes, which can be custom-made by a doctor.
  • Taping: Using standard medical tape or KT tape can provide extra support for the Achilles tendon as well as relieving some of the pain. More detailed instructions on taping  can be found below.
  • Anti-Inflammatory Medicine: Taking medicine that is specifically for decreasing inflammation, such as ibuprofen, is highly effective at treating numerous running injuries, including Achilles tendonitis. These can come in pills or topical creams, and are available over-the-counter or via prescription for stronger doses.
  • Stretching: Specific stretches targeting the affected areas of tendinopathy have been shown to help reduce pain and inflammation in many cases, and can prevent it from reoccurring as well. More information on specific stretches can be found below, but different stretches work for treating insertional or noninsertional tendinopathy.
rest-kt-tape
Wikimedia Commons

Stretches for Treating/Preventing Noninsertional Achilles Tendinopathy

These are stretches you can do at home to treat pain and swelling from noninsertional tendinopathy, or pain located higher up on the foot. These are focused more on the calves, as opposed to the insertional variety of tendonitis which focuses on the heel. Some of these stretches are used in physical therapy, but they can also be done on your own in order to strengthen the muscles and combat excessive tightness. Some of these stretches will require a resistance band.

  1. Drive Back: Attach a resistance band to your leg and a post or doorjamb. Facing the structure, lift the banded leg back while standing on the other. Slowly return to starting position. Repeat 25 times for each leg.
  2. Glute Bridge: Lie on your back with both knees bent. Lift one foot so that the leg is fully stretched outward. Lift your pelvis and hold for a few seconds. Do 20 reps for each leg.
  3. Donkey Kick: Kneel on all fours, with a resistance band wrapped around the bottom of one foot and held by your opposite arm. Extend the banded leg fully, hold and slowly return to starting position. Do 20 reps with each leg.
  4. Standing Calf Stretch: Leaning forward with both hands on a wall, straighten one leg behind you in a lunging position. Hold for 30 seconds on each side, switching legs for 5 minutes.

Stretches for Treating/Preventing Insertional Achilles Tendinopathy

As with the stretches for noninsertional Achilles tendinopathy, these will help strengthen the tissue and surrounding muscles in order to treat and prevent injury. However, these stretches are designed to target the area located near the heel: the area affected by insertional tendinopathy. You may need a resistance band or step in order to perform some of these stretches.

  1. Double Heel Rise: Standing upright, lift both heels off the ground so you stand on the tips of your toes. Hold for a few seconds, then slowly lower back to the ground. Do three sets of 10.
  2. Heel Drop: Stand on the edge of a stair or step with your heels hanging off. Balancing carefully, lower both your heels until they’re fully extended. Slowly raise and repeat 20 times, then repeat the movement with one heel at a time in sets of ten.
  3. Toe Stretch: Sit on the floor with the knee of one leg bent, and the other straight. Attach a resistance band under the arch of the outstretched foot, with the other end held in your hand. Apply tension with the band, flexing your toes. Hold for 10-20 seconds, then repeat with the other foot.

Using KT Tape for Treating Achilles Tendonitis

This is a step-by-step outline of how to use Kinesio tape, or KT tape, to treat the effects of tendinopathy. Doing this properly will decrease swelling, provide support and decrease the level of pain in the affected leg.

  1. Lie face down with your affected leg pointed downward, stretching your foot to a comfortable level.
  2. Attach the first piece of tape on the bottom of your foot, over the heel and up to the midpoint of your calf.
  3. Take the second piece of tape and attach it horizontally along the point of most pain.

The end result should look like a cross on the back of your leg.

Medical Procedures for Treating Achilles Tendonitis

In severe cases of Achilles tendonitis, medical procedures may be required in order to properly treat it. These are some procedures doctors may recommend in order to treat your tendinopathy, in order of severity.

  1. Cortisone Injections: This powerful anti-inflammatory steroid is injected directly into the area. It’s a rare procedure, due to the potential of causing a rupture.
  2. ESWT: The scientific basis for this procedure’s effectiveness is still developing. However, Extracorporeal Shockwave Therapy, or ESWT, is a noninvasive treatment method for many cases of tendonitis.
  3. Gastrocnemius Recession: In this surgical procedure, the calf muscle is lengthened, increasing flexibility in the ankle. This procedure is effective in treating excessive tightness as a result of noninstertional tendinopathy.
  4. Debridement: If a specific part of the tissue is damaged, this procedure will remove the damaged portion. If necessary, a tendon transfer may also be performed in order to regain lost tissue.
Wikimedia Commons
Wikimedia Commons

Preventing Achilles Tendonitis

The following methods are effective at keeping Achilles tendinitis from developing in the first place. You are more likely to re-experience tendinopathy if you’ve previously had it, but these methods will also help you if you’ve never had it.

  • Incremental Training: A healthy rate to increase your training regimen is in gradual increments. This means starting at a low level of intensity, and increasing it every week by about 10%.
  • Cross-Training: Similar effects to incremental training can be attained if you switch between different forms of exercise. A training regimen of swimming, biking and running will be less likely to cause this condition than a regimen of just running.
  • Stretches: Implementing the stretches outlined above can be effective treatment as it occurs, but it can also prevent it during times when you feel healthy. It’s a good idea to stretch before exercising in general, as it can prevent a great deal of running injuries.
  • Massage: There are a variety of massages you can do by yourself or with the aid of a physical therapist. In addition to preventing the onset of tendinopathy, these are great for relieving soreness after an intense workout.

Conclusion

Achilles tendonitis is no fun, whether it’s the insertional or noninsertional variety. It is vital to recognize the symptoms early in order to prevent the onset of more serious problems, and more agonizing pain. Fortunately, there are many methods of treating the pain from tendinopathy as they arise, as well as preventing it from occuring in the future. If you are smart with the way you train, the equipment you use, and the exercises you use to cool down afterward.

Sources used when conducting our research

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