Tendons are cords of fibrous tissue that connect muscles to bones. The Achilles tendon connects the calf muscles to the back of the heel, and is the largest tendon in the body. Together, this tendon and muscle cause the foot to point down.
Achilles tendonitis will occur when this tendon becomes irritated or inflamed. Sometimes, a small tear will occur through the Achilles tendon, but it will continue to function. Inflammation frequently starts where the tendon attaches to the heel bone.
Strenuous and often repetitive activities may cause injuries in the Achilles tendon. Unusual or sudden stretching as with repeated jumping or running may lead to Achilles tendonitis. Calcium deposits or ‘bone spurs’ may develop behind the heel. People are at risk of getting Achilles tendonitis if the calf muscle is too tight. Occasionally, Achilles tendonitis is due to an inflammatory arthritic disease called reactive arthritis and can be particularly severe.
When the ankle and foot are at rest there is less pain, but it usually will feel painful behind the heel or into to lower calf muscle when standing up after a period of sitting or lying down, such as first walking in the morning. If the Achilles tendonitis is related to an athletic activity, it may become more painful during the sport or immediately afterward.
Along with a history of any injury or abnormal stress on the foot or ankle, an examination using specific motions may suggest a problem with the Achilles tendon. The tendon may feel thicker than the other side, or have bumps or nodules in it. X-rays may be ordered, but usually are not necessary unless there has been an injury, or the pain is not improving with rest. Because the tendon is made of soft tissue, X-rays or CT scans may be normal even if Achilles tendonitis is present. If necessary, an MRI or ultrasound will show if there is a tear or inflammation of the Achilles tendon.
The treatment depends upon whether there is severe pain or a significant tear in some part of the tendon. In general, if pain does not improve with rest and ice, medical evaluation is a good idea. Physical therapy and anti-inflammatory medications may be recommended to reduce pain. If weakness is present, or the symptoms do not improve, MRI or ultrasound tests may be ordered to make sure the tendon is not torn. Cortisone injections into the region around the Achilles tendon usually are avoided as they may weaken the tendon. Unless there is a tear in the tendon, surgery rarely is necessary.
Various medications may be used to reduce pain. These may include over the counter medications such as Tylenol (generic = acetaminophen) Aleve (generic = naproxen), Motrin (generic = ibuprofen) or aspirin. Prescription medications which belong to a group of medications called ‘non-steroidal anti-inflammatory medications (or ‘NSAIDs’ for short) are commonly recommended. Some of the more commonly prescribed of these include medications such as Celebrex, Motrin, Naprosyn, Mobic, Voltaren, Relafen and Lodine. (a complete list is available at the reference below).