What is Achilles tendonitis/tendinopathy?
The Achilles tendon connects the main calf muscles in the leg to the heel bone (calcaneum) in the foot. It is the most important tendon of the ankle and foot as it facilitates push-off from the ankle required in walking, running, climbing and jumping. Because of its constant use and poor blood supply, like with most other tendons in the body, it can be prone to injury and/or degeneration, and lead to tendonitis (inflammation of the tendon which is usually acute) or tendinosis/tendinopathy (chronic degeneration of the tendon). This can occur at the body of the Achilles tendon or at its insertion onto the calcaneal tuberosity.
What are the symptoms of Achilles tendonitis/tendinopathy?
Achilles tendonitis is caused by repetitive stress of the tendon, including from a sudden increase in the amount or intensity of exercise activity, a significant gain in body weight over time, tight calf muscles, or a bone spur at the back of the heel. It usually presents as pain, stiffness, and swelling along the Achilles tendon that is worse in the morning and aggravated with weight-bearing or physical activity. Pain localised to the back of the heel bone can indicate Achilles insertional tendonitis, which is inflammation of the tendon insertion onto the calcaneum. Over time, this can progress to chronic degeneration of the tendon, which can be asymptomatic or continue to cause dysfunction and predispose to tears in the tendon. Alternatively, a spontaneous Achilles tendon rupture can also occur, typically during a sporting activity that is non-contact, trivial, and without prodromal symptoms, and classically in the male “weekend warrior”.
What are the management options for Achilles tendonitis/tendinopathy?
Non-operative management strategies for Achilles tendonitis or tendinopathy include wearing rocker sole and accommodative supportive shoes to avoid direct pressure on the back of the heel, using a heel raise orthotic and/or cushion padding, losing and maintaining a healthy weight, activity modification by avoiding activities that aggravate symptoms and preferring low-impact exercise in the long term such as swimming, cycling, and Pilates, simple over-the-counter oral analgesia and/or oral or topical anti-inflammatory medication if not contraindicated, and physical therapy. Physical therapy should focus on Achilles tendon and calf stretching and strengthening exercises with progressive loading. The principles of surgical intervention are to debride unhealthy tissue, stimulate healing by encouraging blood supply through contact with healthy tendon tissue, and then repair or reconstruct the Achilles tendon or its insertion, respectively.