What are the other Names for this Condition? (Also known as/Synonyms)

• Achilles Tendinopathy
• Achilles Tendonitis
• Tendinitis of the Heel 

What is Achilles Tendinitis? (Definition/Background Information)

• Achilles Tendinitis is a common injury that occurs when the Achilles tendon is overworked and becomes inflamed. It is the largest tendon in the body that connects the calf muscles at the back of the lower leg, to the heel bone
• The condition is usually caused by any physical activity, such as an athletic sport, which results in repetitive stress on the heel. Overall, there is a high rate of occurrence of this condition among young athletes
• Rest, physical therapy, and over-the-counter medications, are usually the initial recommended measures to treat Achilles Tendinitis. However, surgery is an option, only if the pain does not improve, even after several months of nonsurgical treatment
• The prognosis of Achilles Tendinitis is usually excellent with appropriate treatment 

There are 2 types of Achilles Tendinitis, based upon the part of the tendon that is inflamed.

• Non-Insertional Achilles Tendinitis:
  • In Non-Insertional Achilles Tendinitis, the fibers within the middle area of the tendon have started to degenerate, swell, and thicken
  • This type is more common in younger individuals, who are physically active
• Insertional Achilles Tendinitis:
  • Insertional Achilles Tendinitis affects the lower area of the heel, where the tendon attaches itself to the heel bone
  • Bone spurs (extra bone growth) usually develop with this condition 

With both Non-Insertional Achilles Tendinitis and Insertional Achilles Tendinitis, the injured tendon fibers may also begin to harden (calcify). 

Who gets Achilles Tendinitis? (Age and Sex Distribution)

• Achilles Tendinitis may occur in individuals of all ages, races, ethnic groups, and gender
• Overall, this condition is most commonly seen in middle-aged men
• This condition occurs in approximately 6-18% of runners. It is also more common in athletes, who take part in sports that involve a lot of jumps, such as basketball and volleyball 

What are the Risk Factors for Achilles Tendinitis? (Predisposing Factors)

Common risk factors for Achilles Tendinitis include:

• Middle-aged to elderly men, who are generally physically active
• Any sport that involves a lot of jumping, such as basketball
• Physical abnormalities or defects, such as individual with naturally flat arch in the foot, obesity, and tight calf muscles, may all increase strain in the tendon
• Athletes, who run using worn-out shoes
• Individuals with certain medical conditions, such as diabetes or high blood pressure, have an increased risk of developing Achilles Tendinitis
• Certain types of antibiotics medications, called fluoroquinolones, have also been associated with increased rates of this heel condition 

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider. 

What are the Causes of Achilles Tendinitis? (Etiology)

A few causal factors of Achilles Tendinitis include:

• A sudden increase in the distance run, without giving the body a chance to adjust to the new running program
• The development of bone spurs (extra bone growth) surrounding the area, where the Achilles tendon attach to the heel bone
• Individuals participating in certain sports activities that put a lot of stress on the Achilles tendon, such as basketball, badminton, volleyball, certain track and field events
• Individuals with tight calf muscles; poor flexibility within the calf muscles
• Any traumatic injury to the Achilles tendon 

What are the Signs and Symptoms of Achilles Tendinitis?

The signs and symptoms of Achilles Tendinitis include:

• Pain in the heel along the Achilles tendon, while walking or running
• Inflammation and stiffness of the Achilles tendon, especially observed in the morning
• Severe pain in the Achilles tendon, a day after exercising
• Swelling of the heel that gets worse with exercise
• Weakness in the lower part of the leg 

How is Achilles Tendinitis Diagnosed?

Diagnostic methods that a physician may use to help diagnose Achilles Tendinitis include:

• Physical examination: During a physical examination, the physician will examine the back of the foot and ankle and look for any signs of swelling, tenderness, and pain along the tendon. Individuals are also expected to provide an explanation of the circumstances that caused the injury. In addition to this, a complete medical history can aid in arriving at a definitive diagnosis
• X-ray of the heel: X-rays use radiation to produce images of the joints. Even though x-rays cannot visualize soft tissues, such as tendons, it can help the physician rule out other possible conditions that cause similar symptoms
• Magnetic resonance imaging (MRI) of the heel: An MRI scan is a more detailed scan that uses radio waves and strong magnetic fields, to produce clearer images of the Achilles tendon. This allows the physician to view any damage to the affected area
• General ultrasound imaging of the heel: Ultrasounds are high-frequency sound waves that generate a more detailed image of the soft tissues, such as tendons 

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis. 

What are the possible Complications of Achilles Tendinitis?

The complications of Achilles Tendinitis may include:

• Recurrence of the injury
• Achilles Tendinitis can weaken the tendon, which may result in a rupture of the tendon 

How is Achilles Tendinitis Treated?

Normally, Achilles Tendinitis is treated initially with nonsurgical tools and techniques. However, surgery is an option, if there is no improvement in pain.

Nonsurgical treatments of Achilles Tendinitis include:

• Any activity that further aggravates the condition should be avoided. The physician usually recommends individuals to refrain from all such activities, until the symptoms get better and the tendon heals
• Applying ice to the heel can help reduce pain and swelling
• Compression using wraps or elastic bandages can decrease movement of the tendon, and help reduce swelling
• Non-steroidal anti-inflammatory oral medications, such as ibuprofen or naproxen, may be used to treat Achilles Tendinitis. These medications can help decrease the pain and swelling
• Therapists usually prescribe certain stretching and strengthening exercises that could aid in strengthening and improving the flexibility of the Achilles tendon, and also help reduce any discomfort
• Extracorporeal shock wave therapy (ESWT) is an increasingly popular (US FDA-approved) therapeutic approach in which high-energy sound waves are sent to the heel. However, this therapy is still considered experimental by many physicians; even though, research has shown that it may be effective 

Surgical treatments of Achilles Tendinitis include:

• Gastrocnemius recession: Gastrocnemius recession is the surgical lengthening of the calf (gastrocnemius) muscles. Tight calf muscles put a great deal of stress on the Achilles tendon. This surgical procedure helps individuals, who have a limited range of motion with the heel
• Débridement and repair: This surgical procedure is used to remove the damaged part of the Achilles tendon. After the damaged part of the tendon is removed, the remaining tendon is then completely repaired with sutures or stitches
• Débridement with tendon transfer: In certain cases, where the Achilles tendon is more than 50% damaged, the part of the tendon that is healthy, is not strong enough to function properly. This requires an Achilles tendon transfer to be performed. The tendon within the big toe is moved to the heel bone, which helps strengthen the injured tendon 

How can Achilles Tendinitis be Prevented?

Some of the common recommendations to help avoid or prevent Achilles Tendinitis include:

• Warming-up prior to playing a sport may help minimize the risk for Achilles Tendinitis
• Stretch the calf muscles and Achilles tendon, before and after exercising
• Wearing properly fitting and appropriate footwear (such as shoes that provide adequate cushion for the heel), to help reduce stress on the Achilles tendon
• Perform exercises to strengthen the calf muscles
• Alternate between higher-impact activities, such as running, and lower-impact activities, such as cycling 

What is the Prognosis of Achilles Tendinitis? (Outcomes/Resolutions)

• The prognosis of Achilles Tendinitis is usually excellent with appropriate treatment. Largely, lifestyle changes can usually help improve the symptoms
• However, the symptoms may recur when individuals do not limit the activities that caused the pain. The symptoms may also return, if strength and flexibility in the tendon is not maintained

Additional and Relevant Useful Information for Achilles Tendinitis:

The Achilles tendon is named after Achilles, the mythological Greek hero of the Trojan War.