Achilles Tendinitis

Depending on the affected part of the tendon, Achilles tendinitis can be classified as follows:

• Insertional Achilles tendinitis affects the lower portion of the tendon where it attaches to the heel bone. It often involves calcification or bony spurs and can occur in both active individuals and those who are less physically active.
• Non-insertional Achilles tendinitis affects the fibres in the middle portion of the tendon, usually about 2–6 cm above the heel bone. It is more common in younger active people and often result from overuse or repetitive stress on the tendon during physical activity.

Symptoms of Achilles tendinitis include:

• Pain in the heel, often with stiffness in the morning, which may spread to the calf area.
• Pain worsens with activities, such as walking, running, or exercising.
• Swelling and tenderness at the back of the ankle.

The causes of Achilles tendinitis include:

• Being male and over the age of 30.
• Medical conditions, such as diabetes, rheumatoid arthritis, and thyroid disorders.
• Obesity, tight or weak calf muscles, poor core stability, or joint stiffness.
• Calcium deposits (calcification) or extra bone growth (bone spur) at the tendon.

To identify the underlying cause of Achilles tendinitis and assess the extent of damage, several diagnostics may be used:

• Radiographs (X-rays) can show extra bone growth (spurs) or calcium deposits around the tendon.
• Ultrasonography is a simple and affordable clinic test that can show tendon damage, calcium deposits, or spurs.
• Magnetic resonance imaging (MRI) is suggested for long-standing heel pain to assess tendon degeneration (tendinosis).
   

Based on the severity of the condition, one or more of the following treatment methods are recommended:

• Non-surgical treatment: Non-surgical treatment can help in the early stages of the disease. It may include:
  • Resting and making lifestyle modifications to avoid strenuous activities and prevent injuries.
  • Ice packs help reduce inflammation.
  • Non-steroidal anti-inflammatory drugs (NSAIDs) help ease pain and reduce swelling.
  • Physical therapy, including calf muscle stretches and isometric strengthening(unilateral and bilateral heel drops).
  • Night splints and shoe inserts (orthotics) can keep the foot in a stretched position and reduce stress on the tendon.
  • Extracorporeal shock wave therapy, which uses high-energy or low-energy shock waves around the heel, can help reduce pain and swelling.
• Surgical treatment: Surgical treatment is recommended when all non-surgical options fail. It includes:
  • Removal of the damaged tendon tissue and treating bone spurs or calcium deposits.
  • Gastrocnemius resection may be used for patients with very tight calf muscles who do not improve with other treatments.
  • Minimally invasive surgery is often preferred because it provides pain relief with less tissue damage. 

Patients are advised to consult their doctor if:

• Heel pain persists despite rest.
• Swelling or pain makes it hard to do daily activities.
• Pain gets worse when you exercise.
• You feel a sudden sharp pain that could mean the tendon has torn.

You can lower your risk of Achilles tendinitis by:

• Warming up before exercise and cooling down afterwards.
• Doing stretching and strengthening exercises for your calf muscles.
• Wearing comfortable, supportive shoes that fit well.
• Increasing exercise intensity or duration slowly, not suddenly.
• Maintaining a healthy body weight to reduce pressure on the tendon.

• You may need to see an orthopaedic doctor or a sports medicine specialist for diagnosis and treatment.
• A physiotherapist can help with exercises, recovery, and preventing the problem from coming back.