Achilles Tendon

Common Foot Problems

Common Disorders of the Achilles Tendon

A tendon is a tough band of tissue that connects muscle to bone and is able to withstand tension. The Achilles tendon is located at the back of the lower leg and connects the calf muscle to the heel bone. Otherwise referred to as the “heel cord,” this tendon enables walking by pushing the heel downward and helping to raise the heel off the ground.

Achilles tendonitis and Achilles tendinosis are two disorders that often occur in the heel cord.  Achilles tendonitis is normally a temporary inflammation of the Achilles tendon. If not resolved, the inflammation may lead to Achilles tendonosis, a degeneration of the tendon. This tendon degeneration results in loss of organized structure and most likely leads to microscopic tears. At times, the degeneration involves the site where the Achilles tendon attaches to the heel bone. Rare cases result in chronic degeneration with or without pain that may result in tendon rupture.

Achilles tendonitis and tendonosis, sometimes called “overuse” disorders, are normally caused by a sudden increase of a repetitive activity that involves the Achilles tendon. This sudden increase of activity overstresses the tendon in a short time period that leads to micro-injury of the tendon fibers. Prolonged stress of the tendon prevents the body from repairing the injured tissue, disrupting tendon structure and resulting in ongoing pain.

Athletes are commonly affected by disorders of the Achilles tendon. People with jobs that overstress the ankles and feet, such as laborers, are at high risk as well. “Weekend warriors” - individuals who are less conditioned to undertake athletic activities on the weekends or infrequently - may develop these injuries. Lastly, people with foot deformities and excessive pronation place greater demands on the tendon when walking. Coupled with unstable footwear, their over-pronation could aggravate the Achilles tendon and result in inflammation.

Achilles tendonitis and tendonosis include the following symptoms:

  • Pain that presents with aching, stiffness, soreness or tendonitis within the tendon. These symptoms may be felt anywhere along the tendon’s path, from the point of attachment directly above the heel up towards the area below the calf muscle. Pain is usually felt after getting up in the morning or after periods of rest, then is relieved with motion but becomes aggravated with additional activity.
  • Tenderness and sometimes severe pain when the sides of the tendon are compressed. Less tenderness is normally felt with pressure applied directly to the back of the tendon.
  • In cases of severe degeneration, the tendon may increase in size and develop nodules in the area of tissue damage.

Dr. Radovic diagnosis Achilles tendonitis or tendonosis by examining
the foot and ankle, the range of motaion and condition of the tendon.
X-rays and other imaging studies may be ordered to determine the
extent of the condition.

  • The treatment approaches recommended for Achilles tendonitis or tendonosis are chosen based on the extent of tendon damage and the time period in which the injury has occurred. Early stages that involve sudden (acute) inflammation may benefit from one or more of the following treatments:
  • Immobilizing the foot in a cast or walking boot to reduce forces through the Achilles tendon and advance healing.
  • Applying ice to the injured area to reduce swelling from inflammation. Cover a bag of ice with a thin towel and place it over the affected area for 20 minutes per hour. Never allow ice to sit against the skin without a layer of protection.
  • Ibuprofen, aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) may help reduce pain and inflammation in the early stages of injury.
  • Custom orthotic devices may be recommended to patients with over-pronation or abnormal walking patterns.
  • Wearing a night splint can help maintain a stretch in the Achilles tendon during sleep.
  • Physical therapy that includes stretching exercises. Soft-tissue massage and mobilization, ultrasound therapy, and re-training in walking and running patterns.

When conservative treatments fail Platlet Rich Plasma (PRP) or Extracorporeal Shockwave Therapy (ESWT) maybe recommended.

Surgery may be an option to restore normal tendon function in patients who are unresponsive to non-surgical treatments. Dr. Radovic will consider the patient’s age, activity level, extent of injury and other factors when choosing the most suitable procedure for tendon repair. 

Dr. Radovic may recommend stretching and strengthening exercises of the calf muscles to prevent Achilles tendonitis or tendonosis from coming back after conservative or surgical treatment. Patients should also be sure to wear appropriate shoes for their foot type and activity level so the condition does not return.

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