Achilles tendinitis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Achilles tendinitis is tendinitis of the Achilles tendon, generally precipitated by overuse of the affected limb and is more common among athletes training under less than ideal conditions. It is a painful condition, and typically occurs due to overuse or arthritis. It should not be confused with xanthoma of the tendon, which is the accumulation of cholesterol in patients with familial hypercholesterolemia.

Achilles tendinitis is the inflammation of the Achilles tendon. The tendon does not have good blood supply or cell activity, so this injury can be slow to heal. Injury to the tendon induce blood vessel formation and nerve migration, which is what is thought to cause the pain.

The causes of Achilles tendinitis are mainly overuse (especially in athletes), arthritis in the elderly, injury, bone spurs or infection.

The risk of developing Achilles tendinitis is highest in athletes who are involved in high intensity exercises. Other risk factors include a sudden increase in amount or intensity of exercise, and having tight, poorly conditioned muscles.

A complication of achilles tendonitis is tendon rupture. Lifestyle changes help improve symptoms but the symptoms may return on resuming strenous activities.

Achilles tendinitis presents with pain on gentle palpation of the tendon, soreness and stiffness in the morning, and swelling or warmth over the affected tendon.

Key signs on physical examination are tenderness to palpation over the tendon, and trouble standing on toes.

X-Ray is done to look for arthritis as the possible etiology for the tendinitis.

MRI is required if a tear is suspected.

The non medical therapy for Achilles tendinitis involves treatment mainly with ice packs or a physical rehabilitation program. Medical therapy involves use of NSAIDs and if required, steroid injection. Severe cases may need orthopedic surgery.

Prevention includes appropriate exercise habits and wearing low-heeled shoes.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Achilles tendinitis is the inflammation of the Achilles tendon. The tendon does not have good blood supply or cell activity, so this injury can be slow to heal. Injury to the tendon induce blood vessel formation and nerve migration, which is what is thought to cause the pain.

The Achilles tendon does not have good blood supply or cell activity, so this injury can be slow to heal. The tendon receives nutrients from the tendon sheath or paratendon. When an injury occurs to the tendon, cells from surrounding structures migrate into the tendon to assist in repair. Some of these cells come from blood vessels that enter the tendon to provide direct blood flow to increase healing. With the blood vessels come nerve fibers. Researchers believe these nerve fibers to be the cause of the pain.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

The causes of Achilles tendinitis are mainly overuse (especially in athletes), arthritis in the elderly, injury, bone spurs or infection.

There are two large muscles in the calf: the gastrocnemius and the soleus. These muscles are important for walking, and create the power needed to push off with the foot or go up on the toes. The large Achilles tendon connects these muscles to the heel.

The tendon can become inflamed due to overuse, arthritis, injury, or infection.

In young people, the most common cause is over use, particularly in athletes. Sports that involve extensive walking, running, and especially jumping, can put high levels of stress on the tendon which can lead to tendinitis over time.

In older people, arthritis is a more common cause of Achilles tendinitis.

Additionally, bone spurs or bone growths near the back of the heel can irritate the tendon, leading to tendinitis.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

The risk of developing Achilles tendinitis is highest in athletes who are involved in high intensity exercises. Other risk factors include a sudden increase in amount or intensity of exercise, and having tight, poorly conditioned muscles.

Athletes who practice high-impact sports that involve a lot of jumping may be more likely to develop tendinitis.

One’s risk for developing tendinitis increases if:

• One has had a sudden increase in the amount or intensity of an activity
• Calf muscles are very tight, i.e. not stretched out.

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A complication of achilles tendonitis is tendon rupture. Lifestyle changes help improve symptoms but the symptoms may return on resuming strenous activities.

Achilles tendinitis may make one more likely to have an Achilles tendon rupture. This condition usually causes a sharp pain. Surgical repair is necessary, but difficult because the tendon is not normal.

Lifestyle changes usually help improve symptoms. However, symptoms may return if one does not limit activities that cause pain, or if one does not maintain the strength and flexibility of the tendon.

Surgery, if needed, has been shown very effective for improving pain.

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