What is Achilles tendonitis?
The Achilles tendon connects the calf muscle to the heal bone. It is under constant use use when the body is active, during walking, running and jumping. An excess of such physical activing can result in infammation of the tendon, known as Achilles tendonitis.
Image from BMJ.com
There are two types of Achilles tendonitis :
1. Non-insertional Achilles tendonitis
This involves fibres in the middle portion of the tendon which tears, swells and hardens. It affects mainly younger, more active people.
2. Insertional Achilles tendonitis
Affecting the lower portion of your tendon where it attaches to your heel bone, swelling can be accompanied by calcification, resulting in bone spurs. It tends to affect people of all ages, but is more prevalent in those with a history of excessive exercise (long distance runners?).
Causes of Achilles tendonitis
If you are active, the chance of you suffering tendonitis are greater. Here are a few situations that you may want avoid, or to look out for.
1. Not warming up before exercising.
2. Running in old, worn out, or incorrect shoes.
3. Repetitive stress of the tendon.
Repeated exercise will cause the tendon to tear. Given time these tears will heal. However, without proper breaks in activity these tears will worsen.
4. Sharp increases in the amount and / or intensity of exercise.
Constantly increasing efforts, without allowing time for the body to adapt will increase strain on the tendon.
5. Tight calf muscles.
Some injuries will cause the calf muscles to have reduced flexibility.
6. Bone spur.
Extra bone growth next to where the tendon attaches to heel can cause painfull rubbing of the tendon.
Symptoms of Achilles tendonitis
Below are a few symptoms to look out for. Typically symptoms will start mild mild. However, unless treated, the pain will increase with time.
1. A sharp pain approximately half way between the heel and calf muscle.
2. The pain increases with activity, being most notable 1 - 2 hours after exertion.
3. Pain is most intense after running fast or long distance, or climbing stairs.
4. Thickening of the tendon into a lump.
5. The tendon 'creaks' when touched.
6. Formation of a bone spur (insertional tendinitis).
Treatments for Achilles tendonitis
Although more likely in active, athletic people, there are a few things you can do to prevent or recover from Achilles tendonitis.
1. R.I.C.E. (Rest, Ice, Compress, Elevate)
Rest - Give the injury time to heal. Lower the intensity of effort, or even better, take a break (days to weeks) from exerting the tendon altogether.
Ice - Ice packs, and similar (bag of peas, etc) will alleviate the pain and inflammation, especially after exercise.
Compress - compress the injured area or wrap in an elastic bandage, making sure to any wrapping is not too tight.
Elevate - Raise the injured leg, ideally above the level of your heart, to prevent swelling.
2. Non-steroidal anti-inflammatory drugs (NSAIDs).
Drugs, such as ibuprofen, will reduce inflammation.
Stretching the calf muscle will help strengthen the muscle and reduce tension on the tendon.
Massaging the tendon, especially any swelling, will help reduce tension.
5. Heel lifts.
Heel lifts take pressure off the heel, reducing stress on the tendon.
NOTE: If home treatment doesn't work, it's important to see a doctor. If your tendonitis gets worse, your tendon can tear. You may need medication or surgery to ease the pain.
6. Cortisone injections.
Cortisone is a powerful anti-inflammatory steroid. However, it is rarely recommended because they can cause the tendon to rupture.
Severe or persistant tendonitis, that shows no sign of improvement after 6 months, may merit surgery, such as Gastrocnemius Recession (lengthening of the calf muscles) or Débridement and Repair (removal of damaged tissue and repair of the tendon).
Recovery from Achilles tendonitis
Recovery time can vary greatly. If addressed early, and rested and treated in a timely fashion, it can recede in as little as a few days. However, if not treated early enough, recovery will take much longer, most likely a number of weeks.
If surgery is needed, recovery will take anywhere from a few weeks to a several months.
Preventing Achilles tendonitis
Considering the causes, it is easy to understand what actions will help prevent Achilles tendonitis.
1. Warm up before exercising.
A decent warm-up will make the calf muscle more flexible, increasing its ability to take the increased strains of exercise.
2. Stretch the tendon just after waking up.
This allows the tendon to better cope with initial morning strain.
3. Follow an exercise routine that is not constantly increasing effort.
For example, if training for a long distance run (marathon?) have some weeks (1 in 3?) where effort is the same, or slightly less, than the week before.
4. Replace old running shoes
Typically shoes that have run over 500 miles / 800 km should be replaced.