Achilles tendinitis

Achilles tendinitis

Foot and Ankle ​Condition

Achilles tendinitis

Achilles tendonitis is an inflammatory response, although this is very limited because there is little blood supply to the Achilles tendon. Some more suitable descriptions are: inflammation of the sheath that covers the tendon (paratendinitis), degeneration of the inner substance of the tendon (tendinosis) or a combination of both.

Anatomy

The Achilles tendon is the largest tendon in the body. It connects your calf muscles to your heel bone.

The tendon’s blood supply comes from the muscles that are in the upper part of the tendon and from the bone junction of the lower part of the tendon. Blood supply is limited to the “borderline vascular” zone; that is, about 1 to 4 inches above the insertion in the heel bone. Paratendinitis and tendinosis develop in the same area.

Causes

The cause of paratendinitis is not well understood, although there is a correlation with the recent increase in the intensity of exercises that involve running or jumping. It can be associated with repetitive activities that overload the tendon structure, posture problems, such as flat feet or high arch feet; or, problems with footwear or training, such as running on uneven or excessively hard ground or running on sloping surfaces. Tendinosis is also associated with the aging process.

Symptoms

Paratendinitis occurs in younger people. Symptoms begin gradually and spontaneously. Pain and burning sensation are noticed especially during morning activities. It may improve slightly during initial activities, but worsens if more activities are performed. It gets worse with exercise. Over time, the pain is caused by a smaller amount of exercises.

In general, the Achilles tendon swells, is hot and tender in the area that is about 1 to 4 inches above the heel bone. Sometimes friction is noticed with gentle palpation of the tendon during ankle movement.

Tendinosis occurs similarly, but generally in middle-aged people. If severe pain and limited ability to walk occur, this may indicate a partial tear of the tendon.

Treatment

Non-surgical treatment

Most cases are treated successfully without surgery, although this is time consuming and frustrating for active patients. Treatment is less likely to be successful if symptoms have been present for more than six months. Non-surgical management includes nonsteroidal anti-inflammatory drugs, rest, immobilization, activity limitation, ice, contrast baths, stretching and heel lifts.

Surgical treatment

The specific type of surgery will depend on the location of the tendonitis and the percentage of damage that the tendon presents:

  • Gastrocnemius recession.
  • This procedure is useful for patients who still have difficulty flexing their feet, despite a year of calf stretches.
  • Debridement and repair (if the tendon has less than 50% damage).

 
The objective of this surgery is to eliminate the damaged part of the Achilles tendon. Once the unhealthy portion of the tendon has been removed, the remaining tendon is repaired with sutures or stitches to complete the repair.

Debridement and tendon transfer (if the tendon has more than 50% damage).

In cases where more than 50% of the Achilles tendon is unhealthy and requires removal, the remaining portion of the tendon is not strong enough to function alone. To prevent the remaining tendon from tearing with activity, a tendon transfer is performed to reinforce the Achilles tendon.