Achilles tendinitis (patient information)

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 * Assistant Editor-In-Chief: Amanda Chirlin, B.A.

Overview
Achilles tendinitis is the condition when the Achilles tendon is inflamed near the heel. It is a painful condition, and typically occurs due to overuse or arthritis.

What are the symptoms of Achilles tendinitis?
Achilles tendinitis causes pain along the Achilles tendon and in the heel, especially when walking and running.

Symptoms may also include:
 * Pain when the tendon is touched or moved
 * Soreness and stiffness in the morning
 * Swelling and/or warmth of the skin over the tendon
 * Trouble standing on one toe

What causes Achilles tendinitis?
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.

Who is at highest risk?
Athletes who practice high-impact sports that involve a lot of jumping may be more likely to develop tendinitis.

Your risk for developing tendinitis increases if:
 * You have a sudden increase in the amount or intensity of an activity
 * Your calf muscles are very tight (not stretched out)

When to seek urgent medical care?
Achilles tendinitis is not considered a medical emergency. However, if you have pain in the heel around the Achilles tendon that is worse with activity, contact your health care provider for evaluation and possible treatment for tendinitis.

Diagnosis
Your doctor can diagnose you with a physical examination that may include:
 * Checking for tenderness in the tendon
 * Checking you for pain when you stand on one toe
 * X-rays to check for arthritis

An MRI scan may be performed if your doctor is concerned about a tear in the tendon or if the doctor is considering surgery.

Treatment options
Most treatments for Achilles tendinitis do not involve surgery. It is important to remember that it may take at least 2 to 3 months for the pain to go away.

Try putting ice over the Achilles tendon for 15 to 20 minutes, two to three times per day. Be sure to remove the ice if the area gets numb.

Changes in activity may help manage the symptoms. Decrease or stop any activity that causes you pain. Run or walk on smoother and softer surfaces. Switch to biking, swimming, or other activities that put less stress on the Achilles tendon.

Your health care provider or physical therapist can show you stretching exercises for the Achilles tendon.

They may also suggest the following changes in your footwear:
 * A brace or boot to keep the heel and tendon still and allow the swelling to go down
 * Heel lifts placed in the shoe under the heel
 * Shoes that are softer in the areas over and under the heel cushion

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen can help with pain or swelling. Talk with your health care provider.

If these treatments do not improve symptoms, you may need surgery to remove inflamed tissue and abnormal areas of the tendon. Surgery also can be used to remove the bone spur that is irritating the tendon.

Extracorporeal shock wave therapy (ESWT) may be an alternative to surgery for people who have not responded to other treatments. This treatment uses low-dose sound waves.

Where to find medical care for Achilles tendinitis?
Directions to Hospitals Treating Achilles tendinitis

What to expect (Outlook/Prognosis)?
Lifestyle changes usually help improve symptoms. However, symptoms may return if you do not limit activities that cause pain, or if you do not maintain the strength and flexibility of the tendon.

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

Possible complications
Achilles tendinitis may make you more likely to have an Achilles tendon rupture. This condition usually causes a sharp pain, like someone hit you in the back of the heel with a stick. Surgical repair is necessary, but difficult because the tendon is not normal.

Prevention
Prevention is very important in this disease. Maintaining strength and flexibility in the muscles of the calf will help reduce the risk of tendinitis. Overusing a weak or tight Achilles tendon makes you more likely to develop tendinitis.