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Achilles Tendonitis

  • What is achilles tendonitis?

    Achilles tendonitis

    The Achilles tendon is in the back of the ankle, connecting the calf muscles to the heel bone. This tendon is needed for walking, running and jumping. It withstands a great deal of stress during normal daily life. Achilles tendonitis occurs when the muscles and tendon are overused, causing irritation to and swelling of the tendon.

    There are 2 types of Achilles tendonitis:

    • Insertional Achilles tendonitis affects the lower part of the tendon where it attaches to the heel. This can occur at any age.
    • Non-insertional Achilles tendonitis affects the middle part of the tendon and causes swelling and thickening in this area. This is most common among young and active people.

    Hardening (calcification) of the damaged tendon fibres can occur in both types of Achilles tendonitis.

  • Achilles tendonitis is usually caused either by continuous stress (a repetitive, small impact) on the affected area or a sudden injury.

    Risk factors for Achilles tendonitis

    • Age – Achilles tendonitis is more likely to occur in older persons
    • Bone spurs (bony growth) – these form at the back of the heel and irritate the Achilles tendon, causing pain and swelling. This is also more likely with age.
    • Gender – Achilles tendonitis is more common in men.
    • High impact sports or activities – the repeated impact of jumping and landing in sports like basketball or running on hard surfaces can cause injury to the Achilles tendon.
    • Intensive activity – running too much, suddenly increasing the level of activity or running on hilly terrain can increase the risk of tendon strain or injury.
    • Certain medical conditions – individuals with psoriasis or high blood pressure have a higher risk for developing Achilles tendonitis.
    • Certain medications – a type of antibiotics, known as fluoroquinolones, are linked to higher rates of Achilles tendonitis.
    • Obesity – additional weight increases the risk of tendon strain.
    • Physical traits – flat arches place more strain on the Achilles tendon.
    • Poor stretching or warming up prior to exercise – tight calf muscles contribute to strained tendons.
    • Worn-out shoes – poor support contributes to strained tendons.

    Preventing Achilles tendonitis

    • Alternate high-impact activities like running and basketball, with low-impact activities such as swimming and cycling, to prevent undue strain on the Achilles tendon.
    • Make gradual changes to the frequency and intensity of your activities. For example, if you are just beginning a new sport or exercise regime, start slowly before moving on to more advanced levels.
    • Practice moderation. Avoid activities that place excessive strain on the tendons, such as hill running, and stop if you feel pain.
    • Stretch daily, not just before and after exercise. This will help maintain flexibility of the calf muscles.
    • Strengthen calf muscles, to help the Achilles tendon handle the stress of daily activity and exercise.
    • Warm up thoroughly, especially before strenuous exercise.
    • Wear shoes that offer good cushioning and arch support to reduce strain on the tendon, or use orthopaedic inserts in your shoes such as arch supports.
  • The main symptoms of Achilles tendonitis are pain and swelling at the back of the heel. You should consult your doctor if you:

    • Cannot bend your ankle
    • Cannot walk comfortably on the affected side
    • Experience swelling in your calf
    • Have an injury that causes deformity around the joint
    • Have ankle pain at night or while at rest
    • Have ankle pain for more than a few days
    • Experience signs of infection, including fever, redness or warmth
  • Diagnosis of Achilles tendonitis is based on a physical examination and may be confirmed using one or more diagnostic tests. To begin, your doctor will check for symptoms such as swelling or pain on the back of the heel and limited range of ankle movement.

    This may be followed by one of these diagnostic tests:

    • Magnetic resonance imaging (MRI)

      MRI is a tube-shaped machine large enough for a person to slide into its centre. It creates detailed, cross-sectional images of the organs and tissues within the body to reveal if there is tissue degeneration or rupture. This will help your doctor determine the extent of damage and decide on the appropriate treatment.

    • Ultrasound

      Ultrasound uses high-frequency sound waves that bounces off internal tissues, organs and bone. The echo created by these sound waves produce an image that can reveal inflammation or damage in the soft tissues, muscles, blood vessels, tendons, and joints, including injuries such as Achilles tendinitis.

    • X-rays

      X-rays are usually not needed to diagnose Achilles tendonitis, but it may be requested to rule out bone-related causes of pain such as bone spurs on the heel or stress fractures.

  • Treatment of Achilles tendon injuries or Achilles tendonitis depends on the causes, symptoms and extent of the injuries.

    Treatment may include:

    • Heat pads to relax muscles and increase blood flow
    • Ice packs to minimise swelling
    • Non-steroidal anti-inflammatory drugs to reduce pain
    • Physiotherapy to increase strength and regain mobility
    • Rest to treat the swelling
    • Steroid injections to treat the swelling
    • Stretching to loosen the calf muscle

    Surgery is usually only offered as an option for those who experience repeated injuries and persistent pain, if the tendon tears or if there are loose ligaments.

    If you experience pain in your heels or ankles, it could worsen if left untreated. Make an appointment now for diagnosis and appropriate treatment.

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  • Achilles tendonitis may lead to Achilles tendon rupture, which is a partial or complete tear of the tendon. This condition usually causes a severe and sharp pain, requiring surgical repair for treatment.

    Any form of surgery includes risks such as bleeding, infection or complications from anaesthesia. Other complications from tendon repair surgery may include:

    • Nerve damage
    • Difficulty healing
    • Weakness in the calf
    • Continued or recurring pain in the foot and ankle

    You may also face additional risks, which vary depending on your health, age and the condition or shape of your foot, leg muscles and tendons. This may also impact the type of surgery that can be performed.

    Speak to your doctor for more information on the risks and procedures that are recommended for you.

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