Achilles tendinitis is an overuse injury of the Achilles (uh-KIL-eez) tendon, the band of tissue that connects calf muscles at the back of the lower leg to your heel bone.
Achilles tendinitis most commonly occurs in runners who have suddenly increased the intensity or duration of their runs. It’s also common in middle-aged people who play sports, such as tennis or basketball, only on the weekends.
Most cases of Achilles tendinitis can be treated with relatively simple, at-home care under your doctor’s supervision. Self-care strategies are usually necessary to prevent recurring episodes. More-serious cases of Achilles tendinitis can lead to tendon tears (ruptures) that may require surgical repair.
Causes
Excessive exercise is a common cause of Achilles tendonitis. This is particularly true for athletes. However, factors unrelated to exercise may also contribute to risk. Rheumatoid arthritis and infection are both correlated with tendonitis.
In general, any repeated activity that strains the Achilles tendon can contribute to this problem. Here are a few possible causes:
- jumping into an exercise routine without a proper warm-up
- straining calf muscles during repeated exercise or physical activity
- playing sports such as tennis that require quick stops and changes of direction
- wearing old or ill-fitting shoes
- wearing high heels every day
Symptoms
The pain associated with Achilles tendinitis typically begins as a mild ache in the back of the leg or above the heel after running or other sports activity. Episodes of more severe pain may occur after prolonged running, stair climbing or sprinting.
You might also experience tenderness or stiffness, especially in the morning, which usually improves with mild activity.
Diagnosis
To diagnose the condition correctly, your doctor will ask you a few questions about the pain and swelling in your heel. You may be asked to stand on the balls of your feet while your doctor observes your range of motion and flexibility. The doctor may also touch the area directly. This allows him to pinpoint where the pain and swelling is most severe.
Confirming Achilles tendonitis may involve imaging tests:
- X-rays provide images of the bones of the foot and leg.
- Magnetic resonance imaging (MRI) is useful for detecting ruptures and degeneration of tissue.
- Ultrasound shows tendon movement, related damage, and inflammation
Risk Factors
A number of factors may increase your risk of Achilles tendinitis, including:
- Your sex and age. Achilles tendinitis occurs most commonly in middle-aged men.
- Physical problems. A naturally flat arch in your foot can put more strain on the Achilles tendon. Obesity and tight calf muscles also can increase tendon strain.
- Training choices. Running in worn-out shoes can increase your risk of Achilles tendinitis. Tendon pain occurs more frequently in cold weather than in warm weather, and running on hilly terrain also can predispose you to Achilles injury.
- Medical conditions. People who have diabetes or high blood pressure are at higher risk of developing Achilles tendinitis.
- Medications. Certain types of antibiotics, called fluoroquinolones, have been associated with higher rates of Achilles tendinitis.
Treatment
There are a variety of treatments for Achilles tendonitis. These range from rest and aspirin to steroid injections and surgery. Your doctor might suggest:
- reducing your physical activity
- stretching and strengthening the calf muscles
- switching to a different, less strenuous sport
- icing the area after exercise or when in pain
- raising your foot to decrease swelling
- wearing a brace or compressive elastic bandage to prevent heel movement
- undergoing physical therapy
- taking anti-inflammatory medication (e.g., aspirin or ibuprofen) for a limited time
- getting steroid injections
Sometimes more conservative treatments are not effective. In these cases, surgery may be necessary to repair the Achilles tendon. If the condition intensifies and is left untreated, there’s a greater risk of an Achilles rupture. This can cause sharp pain in the heel area.
Prevention
To lower your risk of Achilles tendonitis, stretch your calf muscles. Stretching at the beginning of each day will improve your agility and make you less prone to injury. You should also try to stretch both before and after workouts. To stretch your Achilles, stand with a straight leg, and lean forward as you keep your heel on the ground. If this is painful, be sure to check with a doctor. It is always a good idea to talk to your doctor before starting a new exercise routine.
Whenever you begin a new fitness regimen, it is a good idea to set incremental goals. Gradually intensifying your physical activity is less likely to cause injury. Limiting sudden movements that jolt the heels and calves also helps to reduce the risk of Achilles tendonitis. Try combining both high- and low-impact exercises in your workouts to reduce stress on the tendon. For example, playing basketball can be combined with swimming.
It doesn’t matter if you’re walking, running, or just hanging out. To decrease pressure on your calves and Achilles tendon, it’s important to always wear the right shoes. That means choosing shoes with proper cushioning and arch support. If you’ve worn a pair of shoes for a long time, consider replacing them or using arch supports.
Some women feel pain in the Achilles tendon when switching from high heels to flats. Daily wearing of high heels can both tighten and shorten the Achilles tendon. Wearing flats causes additional bending in the foot. This can be painful for the high-heel wearer who is not accustomed to the resulting flexion. One effective strategy is to reduce the heel size of shoes gradually. This allows the tendon to slowly stretch and increase its range of motion.
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