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Achilles Tendinitis Treatment
Dr Poh Seng Yew
MBBS
MRCSEd
MMED (Ortho)
FRCSEd
What is Achilles Tendinitis?
Achilles tendinitis is a condition characterised by inflammation of the Achilles tendon, the large tendon at the back of the lower leg. This tendon plays a role in movement, connecting the calf muscles to the heel bone. It facilitates activities such as walking, running, climbing stairs, jumping, and standing on tiptoes.
While the Achilles tendon is capable of enduring stress, overuse and degeneration make it susceptible to tendinitis.
Types of Achilles Tendinitis
Achilles tendinitis manifests primarily in two different forms:
Noninsertional Achilles Tendinitis
This occurs when the fibres in the mid-portion of the tendon experience degeneration, leading to small tears, swelling, and thickening of the tendon.
Insertional Achilles Tendinitis
This form involves inflammation and damage to the tendon fibres near their attachment to the heel bone. This can be accompanied by the development of bone spurs.
Causes of Achilles Tendinitis
Achilles tendinitis is usually caused by repetitive stress on the tendon. Several factors can influence this:
- Repetitive or Intense Strain
Regular participation in activities that involve repetitive movements or intense strain on the Achilles tendon, such as running or jumping, can lead to gradual wear and tear. Over time, this can result in tendinitis. - Sudden Increase in Exercise Intensity
A rapid escalation in the amount or intensity of exercise may place excessive strain on the tendon, increasing the risk of tendinitis. - Tight Calf Muscles
If the calf muscles are inflexible or tight, it can place undue stress on the Achilles tendon. This may lead to inflammation, particularly during activities that involve flexing the foot. - Bone Spurs
The development of bone spurs at the heel bone where the Achilles tendon attaches can irritate and inflame the tendon.
Symptoms and Signs
Achilles tendinitis presents a range of symptoms and signs that can vary in intensity.
- Heel or Tendon Pain: A common symptom is pain and stiffness along the heel or the Achilles tendon. This may be more intense in the morning, due to the tendon’s inactivity during the night.
- Pain Exacerbated by Activity: Individuals may experience an increase in pain and swelling in the Achilles tendon during or after engaging in physical activities. This pain can vary in severity.
- Tendon Swelling: Swelling along the tendon is an indicator of inflammation in the Achilles tendon area.
Diagnosis
The diagnosis process for Achilles tendinitis encompasses clinical evaluation and various diagnostic tools.
- Medical Review: An Achilles tendon will review the patient’s medical history, evaluating any past injuries, exercise habits, and any previous symptoms.
- Physical Examination: A thorough examination is conducted, focusing on areas of tenderness, swelling, and any thickening in the Achilles tendon. This includes evaluating the foot and ankle’s flexibility, alignment, range of motion, and reflexes, along with checking for calf muscle tightness.
- Imaging Tests: Achilles tendon specialists may use several imaging techniques to confirm diagnosis. X-rays, while unable to visualise the tendons, can help exclude other conditions with similar symptoms. An ultrasound and MRI can also provide detailed images of the area, aiding in the assessment of tendon degeneration or tears.
Non-Surgical Treatment Options
Achilles tendinitis is primarily treated using non-surgical methods, used to alleviate symptoms and stimulate healing.
Rest and Ice |
Initially, the Achilles tendon specialist may suggest reducing or temporarily stopping activities that aggravate the tendon. Applying ice can also help manage pain and reduce swelling. |
Medications |
Over-the-counter pain relievers like ibuprofen or naproxen can alleviate pain and inflammation. In more severe cases, stronger medications may be prescribed. |
Physical Therapy |
This includes specific stretching and strengthening exercises to facilitate healing and fortify the Achilles tendon and its supporting structures. This may include eccentric strengthening exercises to load or stretch the tendon. |
Orthotic Devices |
Shoe inserts or wedges that slightly elevate the heel can relieve strain on the tendon and provide cushioning, reducing the force exerted on the Achilles tendon. |
Shockwave Therapy |
This method uses low or high-energy shockwaves applied to the Achilles tendon to help stimulate healing. |
Surgical Treatment Options
If the Achilles tendinitis does not improve after 6 months of non-surgical treatments, surgical intervention may be considered.
Gastrocnemius Recession
This surgery focuses on lengthening the calf muscles (specifically the gastrocnemius muscle) to reduce stress on the Achilles tendon. It can be beneficial for patients whose tendon strain is exacerbated by tight calf muscles.
Debridement
In this procedure, the surgeon removes the damaged part of the Achilles tendon. If there is extensive damage to the tendon, debridement might also involve tendon repair.
Tendon Repair
This procedure is necessary when there are severe tears in the Achilles tendon. The surgeon works to repair and reattach the torn sections of the tendon.
Tendon Transfer
If the Achilles tendon is severely damaged, a tendon transfer might be considered. In this surgery, a less important tendon from the foot is used to replace the damaged Achilles tendon.
Prevention Strategies
Preventative measures can help reduce the risk of developing Achilles tendinitis.
- Gradual Increase in Activity Intensity to Avoid Strain - Increase exercise intensity and duration gradually to avoid overstraining the Achilles tendon.
- Sufficient Stretching and Strengthening - Regular stretching of the calf muscles and strengthening exercises for the lower leg muscles can help maintain tendon health.
- Using Proper Footwear to Support the Achilles tendon - Wearing shoes that provide adequate support, particularly for the arch and heel, can reduce stress on the Achilles tendon.
- Avoiding Overpronation - For individuals with flat feet or overpronation, using orthotic devices or choosing footwear that offers stability and motion control can be beneficial.
- Adequate Rest and Recovery after Physical Activities - Ensure adequate rest and recovery time between intense physical activities to prevent overuse injuries.
Dr Poh Seng Yew
MBBS
MRCSEd
MMED (Ortho)
FRCSEd
With over 18 years of experience, Dr Poh Seng Yew is an orthopaedic surgeon specialising in hip, knee, shoulder and elbow surgery, sports medicine, and trauma surgery.
- Former Director of Sports Service, Department of Orthopaedic Surgery, Singapore General Hospital
- Clinical Hip and Sports Medicine Fellow, Orthopädische Chirurgie München (OCM), Germany
- Fellow, Royal College of Surgeons of Edinburgh, FRCSEd (Orthopaedic Surgery)
- Master of Medicine (Orthopaedic Surgery), National University of Singapore
- Member, Royal College of Surgeons of Edinburgh (MRCSEd)
- Bachelor of Medicine, Bachelor of Surgery (MBBS), National University of Singapore
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Shield Plans
Corporate Partners
Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #08-62/63
Singapore 329563
Weekdays: 9.00am – 5.00pm
Saturdays: 9.00am – 1.00pm
Sundays and Public Holidays: Closed
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Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #08-62/63
Singapore 329563
Frequently Asked Questions (FAQ)
What Happens if Achilles Tendinitis is Left Untreated?
If Achilles tendinitis is not addressed, the condition may worsen, potentially leading to increased pain, swelling, and limited mobility. In some cases, ongoing inflammation and stress on the tendon can result in an Achilles tendon rupture, a more severe injury requiring surgical intervention. Early diagnosis and treatment are recommended to address these concerns.
How Long Does Achilles Tendinitis Take to Heal?
The healing time for Achilles tendinitis varies depending on the severity of the condition and the individual’s response to treatment. Generally, with appropriate non-surgical treatments like rest, physical therapy, and proper footwear, patients may see improvement within a few weeks to several months. Consult an Achilles tendon specialist for a personalised treatment plan and accurate prognosis.
What Exercises Can Help Treat Achilles Tendinitis?
Specific stretching and strengthening exercises can aid in the treatment of Achilles tendinitis. These include calf stretches, eccentric heel drops, and exercises to strengthen the lower leg muscles. These exercises should be performed under the guidance of an Achilles tendon specialist to ensure they are done correctly and effectively.
Can I Still Engage in Physical Activity with Achilles Tendinitis?
While moderate physical activity may be possible with Achilles tendinitis, adjust the type and intensity of exercise to avoid aggravating the condition. Low-impact activities such as swimming or cycling are typically more suitable. An Achilles tendon specialist can guide you through safe exercises and suggest appropriate activity modifications suited to your specific condition.