Ease the ache of Achilles tendinitis

Do you play sports? Maybe you’re a weekend warrior who enjoys a long run or a vigorous tennis match on your day off work?

People who play intense sports that require repetitive motions are at risk for a painful condition in the back of the leg called Achilles tendinitis. Their risk increases if they don’t stretch properly or wear proper shoes.

If you suspect you may have Achilles tendinitis, it’s important to consult a foot and ankle orthopedic surgeon to get proper treatment before the problem gets worse.

What is Achilles tendinitis and what causes it?

Your Achilles tendon is in the back of your lower leg. It connects your upper calf muscles to the back of your heel bone, and it’s actually the largest tendon in the body. You use your Achilles tendon when you walk, run, climb stairs, jump or stand on the tips of your toes.

“When you overuse your Achilles tendon or suddenly increase the intensity of your exercise workouts, the tendon becomes irritated and inflamed. This is tendinitis, a common overuse injury,” explains Jeffrey Levy, D.O., a fellowship-trained foot and ankle orthopedic surgeon with Riverside Orthopedic & Sports Medicine Specialists. “In some people, the tendon actually degenerates and develops microscopic tears – a related condition called Achilles tendinosis.”

Who's at risk?

Anyone can develop Achilles tendinitis. Athletes are most at risk. Other factors that raise your risk include:

Suddenly increasing the duration of your exercise workouts – especially if you’re performing an activity that involves repetitive motion, such as running or jumping
Having flat feet or high arches
Wearing worn out shoes
Running on slanted surfaces or hard ground
Performing manual labor that involves repetitive movements with your legs, feet and heels

Signs and symptoms

You may start feeling the pain of Achilles tendinitis right after you wake up in the morning. When you move around, it may feel better, but then it gets worse later as your activity level increases.

Symptoms include:

Aching pain
A burning sensation
Stiffness
Soreness and tenderness of the tendon

If your tendon has developed tiny tears (Achilles tendinosis), you may also experience:

Severe pain and difficulty walking
Enlarged nodules on the back of your leg where the tendon tissue is damaged

To make a diagnosis, a foot and ankle orthopedic surgeon will consider your symptoms and lifestyle. The doctor may also order an MRI to examine the extent of wear and tear on the tendon.

Treating Achilles tendinitis without surgery

Most people get relief for Achilles tendinitis with at-home treatments. Dr. Levy suggests some steps that can provide relief:

Nonsteroidal anti-inflammatory medications (such as ibuprofen)
Rest and activity limits
Ice (to reduce swelling and inflammation)
Contrast baths (alternating between warm and cold water)
Immobilization
Stretching
Heel lifts

Be aware it may take several months for your symptoms to go away completely. And the sooner you seek treatment, the more successful your recovery is likely to be.

If you don’t feel better after several months, your orthopedic surgeon may recommend:

Professional physical therapy sessions
Cast or brace to rest the area completely
Night splints (to keep the Achilles tendon stretched while you sleep)
An arch support or other custom orthotic devices
Shock wave therapy (may improve blood flow and encourage the body to repair itself)
Platelet-rich plasma injections

Will you need surgery for Achilles tendinitis?

Your foot and ankle orthopedic surgeon might suggest surgery if you don’t get relief after trying nonsurgical treatments for three to six months.

“During surgery for Achilles tendinitis, we typically cut out the degenerative or diseased tendon. We also repair any tears within the tendon,” explains Dr. Levy. “To help prevent further scarring of the tendon, we’ll probably ask you to move your leg almost immediately after surgery.”

You may need to take a break from your sports or workouts for 3-6 months toheal completely after surgery for tendinitis.

If you have Achilles tendinosis, the more serious issue, your doctor may suggest a procedure that involves transferring another tendon to the heel bone to help strengthen the Achilles tendon and improve blood supply. Your recovery and healing times depend on your age and extent of the injury.