What is it?

Achilles tendinitis is a common overuse injury that occurs in people of all fitness levels.  The causes can be variable, but one factor that seems to be consistent with all cases is stress to the gastroc and soleus muscles in the calf region with irritation and loading at the tendon insertion at the heel bone.  This stress may be a result of continued forces placed through the tendon structure from activities ranging from standing, walking, exercise, to recreational activity or sport.  A variety of factors that may be present with cases of achilles tendinitis are weakness or tightness of the gastrocsoleus muscle which would place additional stressors on the connective tendon, improper gait pattern, and poor circulation.  There are varying degrees of injury to the achilles tendon ranging from an acute tendonitis which could be present the first 3 months, to a tendinosis which is considered more chronic in nature lasting greater than 2-3 months, and finally a tendinopathy which encompasses all levels of tendon injury including rupture.

So do you have an achilles tendon injury?

Symptoms may include pain or soreness to the heel and the region between your calf muscle and rear foot.  This pain is typically associated with pushing off with the foot or rising up on your toes.  Pain will typically subside with rest, but in more extreme cases can linger even following breaks in activity.  Other associated signs could include weakness with pointing the toes and foot and swelling behind the heel.

How do we treat the problem?

Depending on the severity and how long the problem has persisted, treatment may range from conservative to more aggressive approaches.  Manual physical therapy techniques have strong evidence to support their application in treating the injury.  With a highly acute tendinitis injury, treatment may include:

  • periods of rest from activity
  • use of a slight heel lift to decrease stress to the tendon
  • anti-inflammatory medication such as ibuprofen or naproxen
  • ultrasound modality
  • massage to tight calf muscle structures
  • gentle stretching
  • application of ice after activity

With less irritable tendonitis the treatment may also involve:

  • low impact aerobic conditioning,
  • dynamic warm-up stretching prior to exercise
  • manual therapy PNF exercises designed to work on eccentric control at the achilles tendon which involves the lengthening of the muscle and tendon versus the contraction/shortening involved with raising up on your toes

And finally with chronic tendinosis and end stages treatment to achilles tendinitis:

  • weight bearing functional exercises are incorporated
  • eccentric lowering from a heel raise position including exercises such as raising up with both legs and lowering on the involved injured leg alone

Precautions

For individuals who are currently or have recently taken antibiotics in the fluoroquinolones class of drugs including Levaquin, check with your physician prior to exercise, as these antibiotics have been found to be involved with cases of tendinitis and potential for achilles tendon rupture.  Also, corticosteroid injections can potentially lead to the further weakening of the tendon structure.

Prevention

Ultimately striking a balance between strength training and flexibility is the key to a healthy tendon.  Have a check-up or physical therapist do a structural examination prior to initiating a new sport related activity to ensure proper gait mechanics, joint mobility, flexibility and strength needed for participation.  Doing a proper warm-up routine involving gradual physical movement or dynamic flexibility exercise significantly will reduce the chances for injury.  Also, make sure to stretch properly after intense activity and prolonged standing or walking.  Finally be sure to wear appropriate footwear for specific activities that is not worn out and offers the proper support.