by Smith CM

Achilles Tendinopathy

(Achilles Tendonitis; Achilles Tendinosis)

Definition

Tendons are tough fibers that connect muscle to bone. Tendinopathy is an injury to the tendon. It can cause pain and swelling and make it difficult to move. Tendinopathy may be:
  • Tendonitis—inflammation of the tendon
  • Tendinosis—tiny tears in the tendon with no major inflammation
The Achilles tendon connects the calf muscle at the heel bone. An achilles tendinopathy is pain in this tendon.
Achilles Tendonitis
Achilles Tendonitis
Copyright © Nucleus Medical Media, Inc.

Causes

Tendinopathy is most often caused by overuse of a muscle and tendon. Over time, the regular strain on the tendon causes the structure of the tendon to change.
Overuse of the achilles tendon can happen with:
  • Increasing your speed or running long distances too quickly
  • Suddenly adding strenuous hills or stair climbing to your exercise routine
  • Doing too much too soon after taking time away from exercising
  • A sudden or violent contraction of the calf muscles, such as during an all-out sprint
  • Running too much

Risk Factors

Achilles tendinopathy is more common in older adults due to the aging process. Other factors that may increase your risk of getting achilles tendinopathy include:
  • Improper or badly worn footwear
  • Lack of flexibility of the calf muscles
  • An improper training program—such as increasing intensity too quickly

Symptoms

Symptoms of tendinopathy may include:
  • Tenderness—usually just above the heel bone and often more noticeable in the morning
  • Stiffness that gradually eases as the tendon is warmed-up
  • Pain after activity that gradually worsens
  • Pain along the tendon during and/or after running
  • Swelling in the area of the Achilles tendon
  • Pain at the back of the ankle

Diagnosis

You will be asked about your symptoms and exercise habits. A physical exam will be done and the doctor will check the motion of your ankle. A diagnosis will be made based on the exam and history.
If more damage is suspected or the diagnosis is unclear the doctor may order imaging tests. Tests may include x-rays, ultrasound, or MRI scan.

Treatment

Tendinopathy may take weeks or months to fully heal. Treatments include:

Rest

Full rest is usually not needed. Tendons do need a break from activities that are causing pain. A gradual return to normal activity will decrease the chance of damaging the tendon again.
Other supportive steps may include, icing the area, shoe inserts, or ankle taping. Prescription or over-the-counter medications may be advised to reduce pain.

Physical Therapy

A physical therapist will assess the tendon. Ultrasound and/or massage may be done to help relieve tension.
An exercise program will be created to strengthen and stretch the calf muscles. This can help with recovery and in preventing future injuries.

Prevention

To decrease your chances of getting Achilles tendonitis:
  • Wear appropriate footwear for your sport.
  • Replace footwear that shows signs of wear.
  • Gradually add hill work, stairs, speed, and distance to your routine.
  • Stretch and strengthen the calf muscles regularly.

RESOURCES

American College of Sports Medicine
http://acsm.org
OrthoInfo—American Academy of Orthopaedic Surgeons
http://orthoinfo.org

CANADIAN RESOURCES

Canadian Orthopaedic Association
http://www.coa-aco.org
Canadian Orthopaedic Foundation
http://www.canorth.org

References

Achilles tendinopathy. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114274/Achilles-tendinopathy. Updated April 21, 2016. Accessed September 30, 2016.
Achilles tendinitis. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00147. Updated June 2010. Accessed February 29, 2016.
Common disorders of the achilles tendon. American College of Foot and Ankle Surgeons Foot Health Facts website. Available at: http://www.foothealthfacts.org/footankleinfo/achilles-tendon.htm. Accessed February 29, 2016.
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.
10/26/2010 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T114274/Achilles-tendinopathy: Massey T, Derry S, Moore R, McQuay H. Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev. 2010;(6):CD007402.

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