Achilles Tendonitis

Understanding the Achilles

A tendon is a soft tissue structure that connects muscle to bone.  The Achilles connects the calf muscle to the back of the heel. The Achilles tendon is the largest tendon in the human body.  However, it also one of the most injured tendons in the human body.  The diagram below outlines where the Achilles attaches and what is around it.

What causes of Achilles Tendonitis?

Achilles Tendonitis is caused by a direct injury to the tendon or an overuse of the tendon.  It can be caused by shoes.  It can be caused by a new exercise routine.  There are many things that can cause the Achilles to become painful.  Foot type may also play a role in Achilles pain.  Those with flat feet tend to be more prone to Achilles problems. 

How can you Diagnose Achilles Tendonitis?

In my office I will do a complete physical exam before giving the diagnosis of Achilles tendonitis.  I typically look at how the ankle moves, where the pain is located, how a patient walks, and get a complete history to understand what may have caused the pain and where/when the pain occurs.   Typically an X-ray is needed to evaluate the attachment of the Achilles into the heel bone.  At times an ultrasound or MRI will be used to help understand the problem better.

Certain activity may make Achilles Tendon problems worse:

- Running may aggravate the Achilles, especially if it is on hills or a treadmill.
- A tight calf muscle may make things worse
- Activity that involves sprinting or sudden, quick movement
- Being on your feet all day on a hard surface such as concrete can aggravate the problem
- A new workout regimen may not be good for the Achilles
- Certain shoes-usually those without a heel-may make the pain feel worse

Usually Achilles tendon problems begin slowly, gradually with exercise or activity.  Over time the pain worsens as the Achilles is a tendon that does not get a rest during the day.  We use it with every step and it can get to the point where every step hurts.

Other symptoms:

- Pain in the morning is typical as is pain going from sitting to standing.
- Feeling a firm lump in the Achilles is a sign of severe inflammation.
- Pain and stiffness may extend from the base of the heel all the way up the calf.

How do you prevent Achilles Tendonitis?

Keeping your calf stretched out and strong is one of the best ways to prevent achilles problems.  Regular exercise with proper shoes for your activity will prevent most injuries.  Unfortunately, sometimes it does not matter what you do, you cannot prevent tendonitis.  If you feel symptoms coming on seek treatment immediately.  Quick treatment will prevent the problem from becoming severe.

Treatment Options:

-Using a shoe with a heel will take pressure of of the tendon.
-A small (1/4") heel lift which you can purchase at the drug store can be very helpful
-Medication such as ibuprofen can help the pain and inflammation
-Ice massage for 10-15 minutes a couple times a day can help
-Cross training-eliminate the activity that started the problem-or find another-elliptical machines are a great substiture for running.  Swimming is also a good activity.
-Physical therapy
-A walking cast may be needed in severe cases
-Some basic stretching exercises may be done at home to help reduce the pain. Watch the basic stretching exercises video by Dr. Neuhaus or view the basic stretching exercises handout.
-Injections of steroids or PRP (platelet rich growth factors) could also be used.
-In some cases surgery may be an option.
    -- ESWT(shock wave) can be used 
    --Topaz is also an option. 
    --Open surgery to repair a torn tendon or rupture would be needed if Achilles tendonitis progresses to a tendon tear.

Please remember an accurate diagnosis is always needed to determine the best treatment.  If your pain lasts more than a few weeks you should seek treatment from a podiatrist.  A podiatrist is the expert when it comes to foot and ankle care.

To learn more or to schedule an appointment, you can contact us using the appointment request or contact us form. You can also call the Neuhaus Foot and Ankle office at 615-220-8788 or at our toll-free number 888-713-0906.


Neuhaus Foot & Ankle
300 Stonecrest Blvd. Suite 450
Smyrna, TN 37167
(615) 220-8788