Achilles Tendinitis – What You Need To Know

Achilles tendinitis is a medical condition characterised by pain over the back of the heel and ankle. Achilles tendinitis is caused by inflammation of the Achilles tendon. The calf muscles are attached to the calcaneal (heel) through the Achilles tendon. Inflammation of this tendon (Achilles tendinitis) thus leads to pain over the heel. Achilles tendinitis affects men and women equally.

Risk factors for development of Achilles tendinitis includes:

– Rapid increase in activities such as dancing, running, jumping
– Stiff and tight calf muscles
– Obesity
– Increase weight bearing activities (overuse)
– Flat feet or high arches

Symptoms

Symptoms of Achilles tendinitis:
– Sharp heel pain
– Pain on touch and shoe wear due to pressure
– Warmth and swelling over back of the heel
– Pain worsened with activities

Even though the symptoms and diagnosis of Achilles tendinitis may seem apparent, there are other serious conditions that could present with similar symptoms.

Other conditions that could present with heel pain:
– Nerve compression over the lower back
– Plantar warts
– Gout, rheumatoid arthritis
– Calcaneal stress fracture

Consult an orthopaedic doctor if you show the above symptoms.

Investigations

Achilles tendinitis can be diagnosed clinically without further investigations if the patient’s symptoms and signs are clear. XRays and magnetic resonance imaging (MRI) of the foot may be performed to confirm the diagnosis. Further imaging may sometimes be necessary if the patient has flat feet or high arches. Xrays may show heel spur over the calcaneal. MRI will be able to demonstrate inflammation and degeneration of the Achilles tendon.

Treatment

The treatment for Achilles tendinitis should be individualised according to
– patient demographics (age, occupation, sporting activities)
– Severity of symptoms

All patients with Achilles tendinitis should be given a course of anti-inflammatory medications (oral and/or plasters). Patients should also modify their lifestyle to avoid aggravating activities eg by reducing weight bearing activities such as running or dancing. They should also use cushioned heel inserts to reduce the stress over the Achilles tendon. Patients should also undergo calf muscle and Achilles tendon stretching physiotherapy. Extra-corporeal shock wave therapy is another form of non-invasive treatment. Shockwave therapy has been shown to stimulate healing and reduce inflammation. If symptoms persist after non-invasive treatment, the next option would be steroid injection. However, there is a risk of Achilles tendon rupture secondary to steroid injection, so this option is generally avoided. Platelet rich plasma (PRP) would be another option for Achilles tendinitis treatment. Platelet rich plasma is a form of regenerative medicine using patients’ own blood and nutrients for healing.

For patients with severe symptoms that are not relieved by the non-surgical treatments, the next treatment option would be surgical release of the tight Achilles tendon and removal of the degenerated tendon. This surgery involves controlled release of the Achilles tendon. The surgical release can be performed open or using an arthroscope (keyhole surgery). Your orthopaedic surgeon will discuss in detail regarding the pro and con for each option. Open Achilles tendon release involves making an incision over the heel and removing unhealthy tissue. Arthroscopic Achilles tendon release (keyhole) can be performed by two small incisions over the heel and calf. The surgery will be performed under general or regional anaesthesia. The surgery will take about 1 hour. You can be discharge on the same day. Your surgeon will review your condition regularly after surgery to make sure your recovery is on track.