Tendinitis of the heel

Alternative names
Achilles tendinitis

Definition
Achilles tendinitis is inflammation, irritation, and swelling of the Achilles tendon (the tendon that connects the muscles of the calf to the heel).

Causes, incidence, and risk factors

There are two large muscles in the calf, the gastrocnemius and soleus. These muscles generate the power for pushing off with the foot or going up on the toes. The large Achilles tendon connects these muscles to the heel.

These are important muscles for walking. This tendon can become inflamed, most commonly as a result of overuse or arthritis, although inflammation can also be associated with trauma and infection.

Tendinitis due to overuse is most common in younger individuals and can occur in walkers, runners, or other athletes, especially in sports like basketball that involve jumping. Jumping places a large amount of stress on the Achilles tendon.

Tendinitis from arthritis is more common in the middle aged and elderly population. Arthritis often causes extra bony growths around joints, and if this occurs around the heel where the Achilles tendon attaches to the heel bone, the tendon can become inflamed and painful.

Symptoms

Symptoms usually include pain in the affected heel when walking or running. The tendon is usually painful to touch and the skin over the tendon may be swollen and warm.

Achilles tendinitis may predispose the patient to achilles rupture. Patients who experience this usually describe the injury as a sharp pain, like someone hit them in the back of the heel with a stick.

Signs and tests

On physical exam, a doctor will look for tenderness along the tendon and for pain in the area of the tendon when the patient stands on their toes.

Imaging studies can also be helpful. X-rays can help diagnose arthritis and an MRI will demonstrate inflammation in the tendon.

Treatment

The initial treatment for Achilles Tendonitis is usually non-steroidal anti-inflammatory drugs (NSAIDs), like aspirin and ibuprofen, and physical therapy to stretch the muscle-tendon unit and strengthen the muscles of the calf. In addition, any activity that aggravates the symptoms needs to be limited.

Occasionally, casting is used to immobilize the heel and allow the inflammation to quiet down. Functional braces or boots have also been used to limit ankle motion and help with inflammation.

If conservative treatment fails to improve symptoms, surgery may become necessary to remove inflamed tissue from around the tendon and to remove any part of the tendon that has become abnormal.

Expectations (prognosis)

Conservative therapy is usually successful in improving symptoms, although they may recur if the offending activity is not limited or if the strength and flexibility of the tendon is not maintained.

When necessary, surgery has been shown to be very effective in improving pain symptoms. However, if pain does not improve with treatment and vigorous activity is continued, the tendon is at risk of completely tearing.

Complications

The worst complication is tearing of the tendon. This occurs because the inflamed tendon is abnormal and weak and continued activity can cause it to rupture. In this case surgical repair is necessary, but made more difficult because the tendon is not normal.

Calling your health care provider

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.

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 is a set-up for tendinitis.

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