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Achilles Tendinitis – Causes and Treatment

Achilles tendinitis is a painful inflammation of the Achilles tendon, most commonly caused by overuse. It frequently affects athletes and physically active individuals.

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Things worth knowing about "Achilles Tendinitis"

Achilles tendinitis is a painful inflammation of the Achilles tendon, most commonly caused by overuse. It frequently affects athletes and physically active individuals.

What is Achilles Tendinitis?

Achilles tendinitis (also called Achilles tendinopathy) is an inflammatory or degenerative condition affecting the Achilles tendon – the largest and strongest tendon in the human body, connecting the calf muscles to the heel bone. The condition causes pain and stiffness around the heel and lower calf and is particularly common among runners, athletes, and physically active people, though it can affect anyone.

Causes

The most common cause is mechanical overuse of the tendon. Typical contributing factors include:

Sudden increase in training intensity or volume
Inappropriate or worn-out footwear
Foot misalignment (e.g., flat feet or overpronation)
Tight or shortened calf muscles
Insufficient warm-up before physical activity
Training on hard surfaces
Age-related degeneration of tendon tissue
Certain antibiotics (e.g., fluoroquinolones), which can weaken tendon tissue as a side effect

Symptoms

Symptoms typically develop gradually and may include:

Pain along the Achilles tendon, especially with the first steps in the morning
Stiffness and start-up pain after periods of rest
Tenderness when pressing on the tendon
Swelling or thickening of the tendon
Pain that worsens with physical activity

Diagnosis

Diagnosis is primarily based on a clinical examination. A doctor will palpate the tendon and assess the location and nature of the pain. Additional diagnostic tools may include:

Ultrasound (sonography): To visualize thickening, micro-tears, or fluid accumulation within the tendon
Magnetic Resonance Imaging (MRI): For detailed assessment of tendon tissue, especially in severe cases or when a tendon rupture is suspected
X-ray: To rule out bony changes or calcifications near the tendon

Treatment

Conservative Treatment

The majority of cases respond well to non-surgical treatment:

Rest and activity modification: Reducing or avoiding pain-provoking activities
Ice therapy: Applying ice packs to reduce pain and swelling during the acute phase
Physiotherapy: Targeted stretching and strengthening exercises, particularly eccentric calf raises (e.g., the Alfredson protocol)
Orthotic devices: Heel lifts or custom insoles to relieve stress on the tendon
Anti-inflammatory medication: Short-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen for pain relief
Extracorporeal shockwave therapy (ESWT): For chronic or treatment-resistant cases

Surgical Treatment

Surgery is rarely required and is only considered when conservative treatment has failed over an extended period, or in the case of a complete tendon rupture. Surgical options may include removal of degenerated tissue or reconstruction of the tendon.

Prognosis and Prevention

With consistent treatment, Achilles tendinitis typically resolves fully, although recovery may take several weeks to months. Preventive measures include:

Regular stretching of the calf muscles
Gradual and progressive increases in training load
Wearing supportive and well-cushioned footwear
Allowing adequate rest and recovery between training sessions

References

Maffulli N., Khan K.S., Puddu G. - Overuse tendon conditions: Time to change a confusing terminology. Arthroscopy (1998).
Alfredson H., Pietilä T., Jonsson P., Lorentzon R. - Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. American Journal of Sports Medicine (1998).
van der Vlist A.C., Breda S.J., Oei E.H.G., Verhaar J.A.N., de Vos R.J. - Clinical risk factors for Achilles tendinopathy: a systematic review. British Journal of Sports Medicine (2019).

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