Achilles Tendinopathy

Overview

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 or tendinosis:

  • 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. Achilles tendinopathy is pain in this tendon.

Achilles Tendonitis
Achilles Tendonitis
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Causes

Tendinopathy is most often caused by overuse of a muscle and tendon. Over time, the strain on the tendon causes changes in the tendon. This change leads to pain.

Overuse of the Achilles tendon can happen in many ways. Some examples include:

  • Increasing your speed or running long distances too quickly
  • Suddenly adding strenuous hills or stair climbing to your exercise routine
  • Stressing the calf muscles too soon after taking time away from exercising
  • A sudden or violent contraction of the calf muscles, such as during an all-out sprint

Risk Factors

Older adults have a higher risk due to the aging process. Other factors that may increase your risk of getting Achilles tendinopathy include:

  • Improper or worn-out footwear
  • Lack of flexibility of the calf muscles
  • An improper training program—such as increasing intensity too quickly

SymptomsandDiagnosis

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. The motion of your ankle will be checked. A diagnosis will be made based on the exam.

If the diagnosis is unclear, then the doctor may order imaging tests such as:

  • X-rays
  • Ultrasound
  • MRI scan

These tests may also be done if other damage may be present.

Treatments

Treatment

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

Rest and Support

The tendon will need a break from movements that are causing pain. However, full rest is not needed.

Other supportive steps may include:

  • icing the area
  • Shoe inserts
  • Ankle taping
  • Medicine (prescription or over-the-counter)—to help manage 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 prevent future injuries.

Prevention

To decrease your chances of getting Achilles tendinopathy:

  • Wear appropriate footwear for your sport.
  • Replace footwear that shows signs of wear.
  • Gradually increase speed, distance, or intensity. This includes increasing hill work or stairs.
  • Stretch and strengthen the calf muscles regularly.

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Edits to original content made by Denver Health.

a (Achilles Tendonitis; Achilles Tendinosis)

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 January 22, 2018. Accessed February 22, 2018.

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 22, 2018.

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 22, 2018.

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.

Derry S, Moore RA, Gaskell H, McIntyre M, Wiffen PJ. Topical NSAIDS for acute musculoskeletal pain in adults. Cochrane Database of Syst Rev. 2015;(6):CD007402.

Irwin TA. Current concepts review: insertional achilles tendinopathy. Foot Ankle Int. 2010;31(10):933-939.

McCormack JR, Underwood FB, Slaven EJ. Eccentric exercise versus eccentric exercise and soft tissue treatment (Astym) in the management of insertional Achilles Tendinopathy: A Randomized Controlled Trial. Sports Health.2016;8(3):230-237.

Zwiers R, Wiegerinck JI, van Dijk CN. Treatment of midportion Achilles tendinopathy: an evidence-based overview. Knee Surg Sports Traumatol Arthrosc. 2016;24(7):2103-2111.

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.