Achilles Tendinitis

This page describes the condition of Achilles Tendinitis and the approach to this condition adopted by Mr Bowyer, at the Wessex Nuffield Hospital. Other surgeons may use variations on the techniques, for instance with regard to post-operative management. It is important that you understand what your own surgeon intends to do, and how you will be treated after the procedure.

Achilles tendinitis is characterized by inflammation and pain at the Achilles tendon (back of the ankle). This tendon, sometimes called the heel cord, is the tendon attachment of the calf muscles from the leg and knee to the heel. This structure is important in standing on your toes or in the pushing-off phase of walking, running, or jumping.

Achilles tendinitis is usually a strain of the tendon.

• Pain, tenderness, swelling, warmth, and redness over the Achilles tendon
• Pain with ankle motion (especially pushing off or pushing down with the front of the foot) or standing on the ball of the foot or toes
• Crepitation (a crackling sound) when the tendon is moved or touched

• Strain from sudden increase in amount or intensity of activity or overuse of the lower leg muscles and Achilles tendon
• Direct blow or injury to the lower leg, foot, or ankle

• Sports that require sudden, explosive calf muscle contraction, such as those involving jumping and quick starts or kicking, especially squash, badminton, basketball and netball
• Running sports, especially training running on hills
• Poor physical conditioning (strength and flexibility/endurance)
• Inadequate warm-up before practice or play

• Appropriately warm up and stretch before practice or competition. Click here for examples
• Allow time for adequate rest and recovery between practices and competition
• Maintain appropriate conditioning
  • Ankle and leg flexibility
  • Muscle strength and endurance
  • Cardiovascular fitness
• Use proper technique
• To help prevent recurrence, taping, protective strapping, or an adhesive bandage may be recommended for several weeks after healing is complete

• An acute injury is usually curable within 6 weeks if treated appropriately with conservative treatment and resting of the affected area
• A chronic condition may take many months to heal

• Healing time will be prolonged if the condition is not appropriately treated or if not given adequate time to heal
• Symptoms can reoccur if activity is resumed too soon
• Untreated, tendinitis may result in Achilles Rupture requiring surgery

General Treatment Considerations

Initial treatment consists of medication and ice to relieve the pain, stretching and strengthening exercises (Click here for examples), and modification of the activity that initially caused the problem. Referral to a physiotherapist for further evaluation and treatment may be helpful. Occasionally a walking boot or cast may be recommended to immobilize the tendon, allowing the inflammation to settle down. For less severe cases or after immobilization, a heel lift may be prescribed to reduce stress to the tendon. This may be followed by an elastic bandage wrap of the ankle and Achilles tendon. Orthotics (arch supports) may be prescribed or recommended after careful assessment with the surgeon and a podiatrist. Surgery to remove the inflamed tendon lining or degenerated tendon tissue is rarely necessary.

• Nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen if you are able to take these
• Cortisone injections are rarely if ever indicated. Cortisone injections may weaken tendons, so it is better to give the condition more time to heal than to use them

• Heat may be used before performing stretching and strengthening activities prescribed by your physician, physical therapist, or athletic trainer. Use a heat pack or a warm soak
• Cold is used to relieve pain and reduce inflammation for acute and chronic Achilles tendinitis. Cold should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage