Achilles Tendonitis

What is Achilles Tendonitis?

Tendonitis by definition means inflammation of the tendon.  Achilles tendonitis is the name we give to painful symptoms of the Achilles tendon.  This can affect the back of the heel or just higher up from this.

What are the causes of achilles tendonitis?

The tendon inserts into the back of the heel and is connected with the calf muscle.  Overuse and tightness of this tendon can develop symptoms. Discomfort is typically worse in the morning and can subside with mild activities. 

Following more high impact activities such as running, the associated pain can reside as a mild ache at the back of the leg or behind the heel.

Investigation for achilles tendonitis

Examination of the tendon may be enough to confirm diagnosis, but in some cases, imaging can be helpful. Typically an ultrasound or MRI would be suggested. 

Treatment for achilles tendonitis

Calf stretches are usually advised, you can speak with a physiotherapist or podiatric specialist for advice on the type and frequency of exercises to carry out. Stretching/ physiotherapy exercises may be suggested in combination with one/ all of the below. 

Orthotics (insoles) can help control the mechanics of the foot and can include a small heel raise to reduce tightness.

A course of shockwave therapy may be suggested, where low level sound waves increase blood flow to the region and promote healing. Typically a course of three sessions is recommended.

Ultrasound guided steroid injections may be advised in some cases, there can be a risk of rupture to the tendon so typically an air cast boot will be provided to mobilise in for 1-2 weeks.

As a last resort, surgery may be suggested. This can include 

  • gastrocnemius recession – reducing the excessive tension/ shortening of the muscle at the back of the leg, that is associated with destructive effects of the foot. This procedure is typically carried out in combination with additional surgeries. 
  • Debridement – where diseased or damaged tissue is removed from the achilles tendon, with the aim to allow new healthy tissue in its place.