Ankle > Achilles Tendinitis

What is the Achilles Tendon?

You can feel your Achilles tendon beneath the skin on the back of your ankle. It is a fibrous band of tissue that connects your calf muscles to your heel bone (calcaneus), which allows you to lift your heel off the ground.

Most commonly an overuse injury, the term Achilles tendinitis commonly refers to:

   Acute inflammation in the sheath surrounding your tendon;

   Chronic damage to the tendon itself, called tendinosis;

   A combination of the two.

Achilles tendinitis can range from mild inflammation to, in rare cases, a tendon rupture. One type of tendinitis, called insertional Achilles tendinitis, can affect the end of the tendon where it attaches to your heel bone. Achilles tendinitis also can be associated with other foot problems, such as painful flat feet.

Causes [top]

Unusual use or overuse of the lower leg muscles and Achilles tendon is usually the cause of Achilles tendinitis. Repetitive jumping, kicking, and sprinting can lead to Achilles tendinitis in both recreational and competitive athletes. Runners, dancers, and athletes over age 65 are especially at risk. Sudden increases in training or competition can also inflame your Achilles tendon. For example, adding hills, stair-climbing, or sprinting to your running workout puts extra stress on your Achilles tendon. Improper technique during training can also strain the tendon. Intense running or jumping without stretching and strengthening your lower leg muscles can put you at risk regardless of your age or fitness level. Running on tight, exhausted, or fatigued calf muscles can put added stress on your Achilles tendon, as your tendon may not be ready to quickly start a workout after a period of inactivity. Direct blows or other injuries to the ankle, foot, or lower leg may pull your Achilles tendon too far and stretch the tissue. A hard contraction of the calf muscles, such as can happen when you push for the final sprint in a race, can strain the tendon. People whose feet roll inward, a condition called overpronation, are particularly at risk. Sometimes, shoes with too much heel cushioning put extra strain on the Achilles tendon.


The time it takes to treat Achilles tendinitis without surgery is highly variable, as you may be able to recover faster from tendinitis caused by a direct blow than you can from an overuse injury. Surgery is typically considered if your Achilles tendinitis has not healed after six to 12 months of non-surgical treatment. It is important to visit your physician to rule out other foot problems. Several conditions like plantar fasciitis, stress fractures, heel bursitis and arthritis may be contributing to your foot pain. If left untreated, Achilles tendinitis usually worsens into a chronically painful condition that increases the risk of tendon rupture. This chronic condition is known as tendinitis. Many people mistakenly believe they can play through the pain, but tendinitis can become a serious injury if not treated properly. Resuming activities too soon may increase your healing time and put you at risk for repeated tendon injuries.

Orthopedic Evaluation [top]

Though many people with mild or moderate Achilles tendinitis feel they can treat themselves at home, an evaluation by a physician usually is the best course of action. Because several conditions - such as heel bursitis and tendon tears - have similar symptoms, your physician can check for complications and decide on a specific treatment program for your tendinitis. There usually are three parts to an orthopedic evaluation: medical history, a physical examination, and tests that your doctor may order.


Your physician likely will ask about your activities, which may have caused the tendinitis. You may be asked when the soreness or pain began. If you have had any prior Achilles tendon injuries, your physician will ask about the treatments you have tried in the past. You may be asked how long your Achilles tendon has hurt, and whether you were able to continue playing after you noticed the pain. Your physician may also inquire about your training activity. Physicians also typically ask about other conditions, such as diabetes and allergies, and medications currently being taken. You also may be asked about your physical and athletic goals - information that will help decide what treatment might be best for you and perhaps allow you to achieve those goals.


Physicians usually pinch your Achilles tendon with their fingers to test for swelling and pain. If the tendon itself is inflamed, your physician may be able to feel warmth and swelling around the tissue, or, in chronic cases, lumps of scar tissue. You will probably be asked to walk around the exam room so your physician can examine your stride. To check for complete rupture of the tendon, your physician may perform the Thompson test. Your physician squeezes your calf; if your Achilles is not torn, the foot will point downward. If your Achilles is torn, the foot will remain in the same position.

TESTS [top]

Should your physician require a closer look, these imaging tests may be performed:

   X-rays taken from different angles may be used to rule out other problems, such as ankle fractures.

   MRI (magnetic resonance imaging) uses magnetic waves to create pictures of your ankle that let physicians more clearly look at the tendons surrounding your ankle joint.


   Imaging techniques

Rest, Ice, Medication, Proper Footwear
Surgical Debridement

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