Achilles Tendinitis

What is Achilles Tendinitis

Achilles tendinitis is inflammation of the tough, cord-like band that attaches the lower leg muscles to the heel bone (Achilles tendon). This is usually caused by overusing the tendon and the ankle joint.

Achilles tendinitis usually gets better over time with treatment and caring for yourself at home. It can take weeks or months to heal completely.

What are the causes?

This condition may be caused by:

  • A sudden increase in exercise or activity, such as running.
  • Doing the same exercises or activities (such as jumping) over and over.
  • Not warming up calf muscles before exercising.
  • Exercising in shoes that are worn out or not made for exercise.
  • Having arthritis or a bone growth (spur) on the back of the heel bone. This can rub against the tendon and hurt it.
  • Age-related wear and tear. Tendons become less flexible with age and more likely to be injured.

What are the signs or symptoms?

Common symptoms of this condition include:

  • Pain in the Achilles tendon or in the back of the leg, just above the heel. The pain usually gets worse with exercise.
  • Stiffness or soreness in the back of the leg, especially in the morning.
  • Swelling of the skin over the Achilles tendon.
  • Thickening of the tendon.
  • Bone spurs at the bottom of the Achilles tendon, near the heel.
  • Trouble standing on tiptoe.

How is this diagnosed?

This condition is diagnosed based on your symptoms and a physical exam. You may have tests, including:

  • X-rays.
  • MRI.

How is this treated?

The goal of treatment is to relieve symptoms and help your injury heal. Treatment may include:

  • Decreasing or stopping activities that caused the tendinitis. This may mean switching to low-impact exercises like biking or swimming.
  • Icing the injured area.
  • Doing physical therapy, including strengthening and stretching exercises.
  • NSAIDs to help relieve pain and swelling.
  • Using supportive shoes, wraps, heel lifts, or a walking boot (air cast).
  • Surgery. This may be done if your symptoms do not improve after 6 months.
  • Using high-energy shock wave impulses to stimulate the healing process (extracorporeal shock wave therapy).This is rare.
  • Injection of medicines to help relieve inflammation (corticosteroids). This is rare.

Follow these instructions at home:

If you have an air cast:

  • Wear the cast as told by your health care provider. Remove it only as told by your health care provider.
  • Loosen the cast if your toes tingle, become numb, or turn cold and blue.

Activity

  • Gradually return to your normal activities once your health care provider approves. Do notdo activities that cause pain.
    • Consider doing low-impact exercises, like cycling or swimming.
  • If you have an air cast, ask your health care provider when it is safe for you to drive.
  • If physical therapy was prescribed, do exercises as told by your health care provider or physical therapist.

Managing pain, stiffness, and swelling

  • Raise (elevate) your foot above the level of your heart while you are sitting or lying down.
  • Move your toes often to avoid stiffness and to lessen swelling.

Achilles tendinitis usually gets better over time with treatment and caring for yourself at home. It can take weeks or months to heal completely.

What are the causes?

This condition may be caused by:

  • A sudden increase in exercise or activity, such as running.
  • Doing the same exercises or activities (such as jumping) over and over.
  • Not warming up calf muscles before exercising.
  • Exercising in shoes that are worn out or not made for exercise.
  • Having arthritis or a bone growth (spur) on the back of the heel bone. This can rub against the tendon and hurt it.
  • Age-related wear and tear. Tendons become less flexible with age and more likely to be injured.

What are the signs or symptoms?

Common symptoms of this condition include:

  • Pain in the Achilles tendon or in the back of the leg, just above the heel. The pain usually gets worse with exercise.
  • Stiffness or soreness in the back of the leg, especially in the morning.
  • Swelling of the skin over the Achilles tendon.
  • Thickening of the tendon.
  • Bone spurs at the bottom of the Achilles tendon, near the heel.
  • Trouble standing on tiptoe.

How is this diagnosed?

This condition is diagnosed based on your symptoms and a physical exam. You may have tests, including:

  • X-rays.
  • MRI.

How is this treated?

The goal of treatment is to relieve symptoms and help your injury heal. Treatment may include:

  • Decreasing or stopping activities that caused the tendinitis. This may mean switching to low-impact exercises like biking or swimming.
  • Icing the injured area.
  • Doing physical therapy, including strengthening and stretching exercises.
  • NSAIDs to help relieve pain and swelling.
  • Using supportive shoes, wraps, heel lifts, or a walking boot (air cast).
  • Surgery. This may be done if your symptoms do not improve after 6 months.
  • Using high-energy shock wave impulses to stimulate the healing process (extracorporeal shock wave therapy).This is rare.
  • Injection of medicines to help relieve inflammation (corticosteroids). This is rare.

Follow these instructions at home:

If you have an air cast:

  • Wear the cast as told by your health care provider. Remove it only as told by your health care provider.
  • Loosen the cast if your toes tingle, become numb, or turn cold and blue.

Activity

  • Gradually return to your normal activities once your health care provider approves. Do not do activities that cause pain.
    • Consider doing low-impact exercises, like cycling or swimming.
  • If you have an air cast, ask your health care provider when it is safe for you to drive.
  • If physical therapy was prescribed, do exercises as told by your health care provider or physical therapist.

Managing pain, stiffness, and swelling

  • Raise (elevate) your foot above the level of your heart while you are sitting or lying down.
  • Move your toes often to avoid stiffness and to lessen swelling.
  • If directed, put ice on the injured area:
    • Put ice in a plastic bag.
    • Place a towel between your skin and the bag.
    • Leave the ice on for 20 minutes, 2–3 times a day

General instructions

  • If directed, wrap your foot with an elastic bandage or other wrap. This can help keep your tendon from moving too much while it heals. Your health care provider will show you how to wrap your foot correctly.
  • Wear supportive shoes or heel lifts only as told by your health care provider.
  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • You have symptoms that gets worse.
  • You have pain that does not get better with medicine.
  • You develop new, unexplained symptoms.
  • You develop warmth and swelling in your foot.
  • You have a fever.

Get help right away if:

  • You have a sudden popping sound or sensation in your Achilles tendon followed by severe pain.
  • You cannot move your toes or foot.
  • You cannot put any weight on your foot.

Summary

  • Achilles tendinitis is inflammation of the tough, cord-like band that attaches the lower leg muscles to the heel bone (Achilles tendon).
  • This condition is usually caused by overusing the tendon and the ankle joint. It can also be caused by arthritis or normal aging.
  • The most common symptoms of this condition include pain, swelling, or stiffness in the Achilles tendon or in the back of the leg.
  • This condition is usually treated with rest, NSAIDs, and physical therapy.

Achilles Tendon Rupture

The Achilles tendon is a cord-like band that connects the muscles of your lower leg (calf) to your heel. An Achilles tendon rupture is an injury that involves a tear in this tendon. This tendon is the most common site of tendon tearing.

What are the causes?

This condition may be caused by:

  • Stress from a sudden stretching of the tendon. For example, this may occur when you land from a jump or when your heel drops down into a hole on uneven ground.
  • A hard, direct hit to the tendon.
  • Pushing off your foot forcefully, such as when sprinting, jumping, or changing direction while running.

What increases the risk?

This condition is more likely to develop in:

  • Runners.
  • People who play sports that involve sprinting, running, or jumping.
  • People who play contact sports.
  • People with a weak Achilles tendon. Tendons can weaken from aging, repeat injuries, and chronic tendinitis.
  • Males who are 30–50 years of age, especially those who do not exercise regularly.

What are the signs or symptoms?

Symptoms of this condition include:

  • Hearing a “pop” at the time of injury.
  • Severe, sudden pain in the back of the ankle.
  • Swelling and bruising.
  • Inability to actively point your toes down.
  • Pain when standing or walking.
  • A feeling of giving way when you step on the affected side.

How is this diagnosed?

This condition is usually diagnosed with a physical exam. During the exam, your health care provider may:

  • Touch the tendon and the structures around it.
  • Squeeze your calf to see if your foot moves.
  • Ask you to point and flex your foot.

Sometimes, tests are done in addition to an exam. Tests may include:

  • An ultrasound.
  • An X-ray.
  • MRI.

How is this treated?

This condition may be treated with:

  • Ice applied to the area.
  • Pain medicine.
  • Rest.
  • Crutches.
  • A cast, splint, or other device to keep the ankle from moving (keep it immobilized).
  • Heel wedges to reduce the stretch on your tendon as it heals.
  • Surgery. This option may depend on your age and your activity level.

Follow these instructions at home:

If you have a splint or brace:

  • Do notput pressure on any part of the splint until it is fully hardened. This may take several hours.
  • Wear the splint or brace as told by your health care provider. Remove it only as told by your health care provider.
  • Loosen the splint or brace if your toes tingle, become numb, or turn cold and blue.
  • Do notlet your splint or brace get wet if it is not waterproof.
  • Keep the splint or brace clean.

If you have a cast:

  • Do notput pressure on any part of the cast until it is fully hardened. This may take several hours.
  • Do notstick anything inside the cast to scratch your skin. Doing that increases your risk of infection.
  • Check the skin around the cast every day. Tell your health care provider about any concerns.
  • You may put lotion on dry skin around the edges of the cast. Do notput lotion on the skin underneath the cast.
  • Do notlet your cast get wet if it is not waterproof.
  • Keep the cast clean.

Bathing

  • Do nottake baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
  • If your cast, splint, or brace is not waterproof, cover it with a watertight covering when you take a bath or a shower.

Managing pain, stiffness, and swelling

  • If directed, apply ice to the injured area.
    • Put ice in a plastic bag.
    • Place a towel between your skin and the bag.
    • Leave the ice on for 20 minutes, 2–3 times a day.
  • Move your toes often to avoid stiffness and to lessen swelling.
  • Raise (elevate) the injured area above the level of your heart while you are sitting or lying down. Do notdangle your leg over a chair, couch, or bed.

Driving

  • Do notdrive or operate heavy machinery while taking prescription pain medicine.
  • Ask your health care provider when it is safe to drive if you have a cast, splint, or brace on a leg or foot that you use for driving.

Activity

  • Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
  • Do exercises only as told by your health care provider.

General instructions

  • Do notuse the injured limb to support your body weight until your health care provider says that you can. Use crutches as told by your health care provider.
  • Do notuse any tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. Tobacco can delay bone healing. If you need help quitting, ask your health care provider.
  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

  • Warm up and stretch before being active.
  • Cool down and stretch after being active.
  • Give your body time to rest between periods of activity.
  • Make sure to use equipment that fits you.
  • Be safe and responsible while being active to avoid falls.
  • Each week, do at least 150 minutes of moderate-intensity exercise, such as brisk walking or water aerobics.
  • Spread your workouts over the whole week, instead of just working out intensely one or two days of the week.
  • Make slow, incremental changes in intensity, distance, or time for running or sporting activity.
  • Maintain physical fitness, including:
    • Strength.
    • Flexibility.
    • Cardiovascular fitness.
    • Endurance.

Contact a health care provider if:

  • Your pain and swelling increase.
  • Your pain is not controlled with medicines.
  • You develop new, unexplained symptoms.
  • Your symptoms get worse.
  • You cannot move your toes or foot.
  • You develop warmth and swelling in your foot.
  • You have an unexplained fever.

Achilles Tendinitis Rehabilitation

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do notbegin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your ankle. These exercises also help to relieve pain, numbness, and tingling.

Exercise A: Standing wall calf stretch, knee straight

  1. Stand with your hands against a wall.
  2. Extend your __________ leg behind you and bend your front knee slightly. Keep both of your heels on the floor.
  3. Point the toes of your back foot slightly inward.
  4. Keeping your heels on the floor and your back knee straight, shift your weight toward the wall. Do not allow your back to arch. You should feel a gentle stretch in your calf.
  5. Hold this position for seconds.

Repeat __________ times. Complete this stretch __________ times per day.

Exercise B: Standing wall calf stretch, knee bent

  1. Stand with your hands against a wall.
  2. Extend your __________ leg behind you, and bend your front knee slightly. Keep both of your heels on the floor.
  3. Point the toes of your back foot slightly inward.
  4. Keeping your heels on the floor, unlock your back knee so that it is bent. You should feel a gentle stretch deep in your calf.
  5. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

Strengthening exercises

These exercises build strength and control of your ankle. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise C: Plantar flexion with band

  1. Sit on the floor with your __________ leg extended. You may put a pillow under your calf to give your foot more room to move.
  2. Loop a rubber exercise band or tube around the ball of your __________ foot. The ball of your foot is on the walking surface, right under your toes. The band or tube should be slightly tense when your foot is relaxed. If the band or tube slips, you can put on your shoe or put a washcloth between the band and your foot to help it stay in place.
  3. Slowly point your toes downward, pushing them away from you.
  4. Hold this position for __________ seconds.
  5. Slowly release the tension in the band or tube, controlling smoothly until your foot is back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

Exercise D: Heel raise with eccentric lower

  1. Stand on a step with the balls of your feet. The ball of your foot is on the walking surface, right under your toes.
    • Do notput your heels on the step.
    • For balance, rest your hands on the wall or on a railing.
  2. Rise up onto the balls of your feet.
  3. Keeping your heels up, shift all of your weight to your __________ leg and pick up your other leg.
  4. Slowly lower your __________ leg so your heel drops below the level of the step.
  5. Put down your foot.

If told by your health care provider, build up to:

  • 3 sets of 15 repetitions while keeping your knees straight.
  • 3 sets of 15 repetitions while keeping your knees bent as far as told by your health care provider.

Complete this exercise __________ times per day.

If this exercise is too easy, try doing it while wearing a backpack with weights in it.

Balance exercises

These exercises improve or maintain your balance. Balance is important in preventing falls.

Exercise E: Single leg stand

  1. Without shoes, stand near a railing or in a door frame. Hold on to the railing or door frame as needed.
  2. Stand on your __________ foot. Keep your big toe down on the floor and try to keep your arch lifted.
  3. Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

If this exercise is too easy, you can try it with your eyes closed or while standing on a pillow.

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