Feet > Achilles Tendinitis

What is the Achilles Tendon?

The Achilles tendon is a fibrous band of tissue that connects your calf muscles to your heel bone (calcaneus). It allows you to lift your heel off the ground.

Most commonly an overuse injury, Achilles tendinitis is inflammation in any portion of the Achilles tendon, and can range in severity from mild swelling to a complete rupture. Achilles tendinitis can happen at the same time as plantar fasciitis, causing foot pain in the heel and ankle. Achilles tendinitis also can be associated with other foot problems, such as painful flat feet.av=PAT&doc_id=29" target="_new">William G. Hamilton, M.D., team physician for the New York Knicks and New Jersey Nets.

Achilles tendinitis is typically caused by unusual use or overuse of the lower leg muscles and Achilles tendon. Tightness in the Achilles is the main predisposing factor to strains and tendinitis. Repetitive jumping, kicking, and sprinting can cause Achilles tendinitis in both recreational and competitive athletes. Runners, dancers, and athletes over age 65 are especially at risk. Sudden increases in training or competition can also inflame your Achilles tendon. For example, adding hills, stair climbing, or sprinting to your running workout puts extra stress on your Achilles tendon. Improper technique during training can also strain the tendon. Intense running or jumping without stretching and strengthening your lower leg muscles can put you at risk regardless of your age or fitness level. Running on tight, exhausted, or fatigued calf muscles put added stress on your Achilles tendon. Your tendon may not be ready to quickly start a new workout after periods of inactivity. Direct blows or other injuries to the ankle, foot, or lower leg may pull your Achilles tendon too far and stretch the tissue. A hard contraction of the calf muscles, like pushing for the final sprint in a race, can strain the tendon. People whose feet roll inward, called overpronation, are particularly at risk. Shoes with stiff soles in the ball of the foot, where the toes join the foot, or too much heel cushioning put extra strain on the Achilles tendon when running or walking.av=PAT&doc_id=29" target="_new">William G. Hamilton, M.D., team physician for the New York Knicks and New Jersey Nets.

Most cases of Achilles tendinitis can be treated in about six weeks without surgery, though you may be able to recover faster from tendinitis caused by a direct blow than you can from an overuse injury. Surgery is only considered if your Achilles tendinitis has not healed after six to 12 months of non-surgical treatment. It is important to visit your physician to rule out other foot problems. Several conditions like plantar fasciitis, stress fractures, and arthritis may be contributing to your foot pain. If left untreated, Achilles tendinitis usually worsens into a chronically painful condition that increases the risk of tendon rupture. Many people mistakenly believe they can play through the pain, but tendinitis can become a serious injury if not treated properly. Resuming activities too soon may increase your healing time and put you at risk for repeated tendon injuries.av=PAT&doc_id=29" target="_new">William G. Hamilton, M.D., team physician for the New York Knicks and New Jersey Nets.

Orthopedic Evaluation

There are usually three parts to an orthopedic evaluation: medical history, a physical examination, and tests that your doctor may order.

Your physician likely will ask about your activities, which may have caused the tendinitis. You may be asked when the soreness or pain began. If you have had any prior Achilles tendon injuries, your physician will ask about the treatments you have tried in the past. You may be asked how long your Achilles tendon took to begin swelling, and whether you were able to continue playing after you noticed the pain. Physicians also typically ask about other conditions, such as diabetes and allergies, and medications currently being taken. You also may be asked about your physical and athletic goals – information that will help decide what treatment might be best for you in achieving those goals.

Physicians usually pinch your Achilles tendon with their fingers to test for swelling and pain. You will probably be asked to walk around the exam room so your physician can examine your stride. To check for complete rupture of the tendon, your physician may perform the Thompson test. Your physician squeezes your calf; if your Achilles is not torn, the foot will point downward. If your Achilles is torn, the foot will remain in the same position.

Should your physician require a closer look, these imaging tests may be conducted:

   X-rays taken from different angles may be used to rule out other problems like ankle fractures.

   MRI (magnetic resonance imaging) uses magnetic waves to create pictures of your ankle that let physicians more clearly look at your tendons.

   Imaging techniques

av=PAT&doc_id=29" target="_new">William G. Hamilton, M.D., team physician for the New York Knicks and New Jersey Nets.