Achilles tendonitis can be a bit of a sneaky problem. Often, it starts off with a niggling ache or stiffness, but if left unchecked, it can escalate quickly into something much more painful. Now, I’m sure many of us have had that “rubber-band” feeling at the back of the heel after a jog, but what’s really going on?
The Achilles tendon is a bit of an unsung hero in our bodies. It’s the largest tendon, connecting the calf muscles to the heel bone, and it’s absolutely vital when we walk, run, or jump. So, when this tendon is compromised, whether through overuse or sudden strain, it can stop us in our tracks.
Personally, I’ve seen a fair few cases in my practice at Well Heeled Podiatry. I remember one patient, a keen netball player, who had been pushing through the pain, thinking it was just a bit of tightness. By the time they came in, their tendon was swollen and painful, and they couldn’t even walk without limping. It was a real wake-up call about how easy it is for this issue to sneak up on you, especially for athletes or those who are on their feet a lot.
What is Achilles Tendonitis?
At its core, Achilles tendonitis is simply inflammation of the Achilles tendon. But it’s more than just a bit of soreness. It’s usually caused by repetitive stress or overuse—things like suddenly increasing the intensity of exercise or performing activities that stress the tendon, such as running or jumping.
In my experience, it’s not just the athletes who are at risk. The condition can affect anyone, particularly as we age and the tendons become less flexible and more prone to injury. It’s that constant cycle of pushing your limits without proper recovery time that leads to this inflammation.
The pain typically begins in the back of the heel and can worsen with prolonged activity. It might start as a dull ache but can escalate to sharp, debilitating pain that interferes with walking, climbing stairs, and even standing.
A common experience I hear from my patients is a stiff feeling in the morning when they first get out of bed, like their heel is stuck. This is a hallmark sign of Achilles tendonitis.
Symptoms of Achilles Tendonitis
When it comes to Achilles tendonitis, symptoms can vary depending on the severity of the condition. At first, you might notice a bit of discomfort or tightness, especially after exercise. But if you’ve been pushing yourself harder than usual or haven’t been stretching as much, it can quickly turn into something more noticeable.
I’ve had patients describe it in different ways—some feel it as a tightness in the calf or a slight ache in the heel after a run, while others notice swelling or even heat around the tendon. It’s important to remember that early detection of the symptoms can prevent long-term damage. If you’re experiencing any of the following, it’s time to take a step back and assess the situation:
1. Pain and Stiffness
The most common symptom of Achilles tendonitis is pain along the tendon, especially after physical activity. The pain tends to be most noticeable in the morning when you first get out of bed or after periods of rest. Think about it like when you try to stand up after a long day at work—you feel a bit stiff, and then it loosens up after a couple of steps. That’s your Achilles tendon telling you it’s under strain.
2. Swelling and Warmth
You might notice some swelling around the tendon, and it could feel warmer than usual to the touch. This is because the tendon is inflamed, and the body is trying to heal the area by sending more blood and fluid to the site of injury.
3. Tenderness to the Touch
The area around the heel and just above it may become quite tender to the touch. If you press on the tendon and it feels sore or painful, this could be a sign that the inflammation is worsening.
4. Weakness in the Affected Leg
As the tendon becomes inflamed and weaker, you might notice difficulty pushing off the foot when walking or running. This can lead to compensatory movements that affect your gait and can lead to further issues down the line.
In one case I remember, a regular runner started experiencing pain in their heel. At first, it wasn’t much, just a little discomfort after their runs. But it quickly progressed to a sharp pain, especially when they tried to increase their pace. This patient hadn’t been stretching as much as usual and had increased their running distance. Eventually, they found that even climbing stairs became painful, and their mobility was seriously impacted.
Diagnosis of Achilles Tendonitis
If you’re feeling any of the above symptoms, it’s crucial to get a proper diagnosis from a healthcare professional. While it’s tempting to just “wait it out” or treat the condition at home, getting an accurate diagnosis early can save you a lot of pain and time in the long run.
In my practice, diagnosing Achilles tendonitis starts with a thorough clinical examination. I typically ask about your medical history, your exercise routine, and when the pain started. From there, I’ll do a physical exam, pressing gently along the tendon to check for areas of tenderness, swelling, and pain. This exam will also help me assess your range of motion and check for any imbalances in your gait.
For a more in-depth diagnosis, imaging tests like an ultrasound or MRI may be used. These can show if there are any tears in the tendon, which might indicate a more severe injury or rupture. However, in most cases, a physical exam and your description of the symptoms are enough to confirm the diagnosis.
If the Achilles tendon is left untreated or if it’s repeatedly overstressed, the tendon can become weakened, making it more susceptible to tears. This is why early diagnosis is so important—if we catch it early, we can avoid more serious injuries down the track.
Treatment for Achilles Tendonitis
The good news is that Achilles tendonitis is highly treatable, especially when caught early. In my experience, most cases of Achilles tendonitis can be managed with a combination of rest, rehabilitation, and conservative treatments. Of course, more severe cases may require additional interventions, but with the right approach, recovery is definitely achievable.
Here’s a breakdown of the most effective treatments you might encounter for Achilles tendonitis:
1. Rest and Recovery
The first and most important treatment step is rest. You need to give the Achilles tendon time to heal, and that means taking a break from any activities that could aggravate it, especially high-impact exercises like running, jumping, or even long walks.
I often recommend to my patients that they switch to low-impact activities like swimming or cycling during the recovery period to keep up their fitness levels without putting additional stress on the tendon. I’ve seen patients rush back to their usual activities before they’re fully healed, which often leads to setbacks and prolonged recovery times. Trust me, giving your tendon the time it needs to rest and heal will speed up the process in the long run.
2. Ice Therapy
Applying ice to the affected area can help reduce swelling and pain. I often tell my patients to apply an ice pack for 15 to 20 minutes at a time, several times a day, particularly after any activity that aggravates the pain. It’s an easy and effective way to manage the inflammation.
If you don’t have an ice pack, a frozen peas bag works just as well! The key is to make sure you don’t apply ice directly to the skin; always wrap it in a cloth or towel to prevent frostbite.
3. Compression and Elevation
Compression and elevation can help with swelling and pain. A compression bandage around the affected area can reduce swelling, and elevating the foot while resting (e.g., propping it up on a pillow) encourages fluid to move away from the injured area. This simple technique can make a big difference in how the tendon feels.
4. Pain Relief Medications
Over-the-counter pain relievers, such as ibuprofen or paracetamol, can help reduce inflammation and alleviate the pain. However, I always tell my patients to be cautious with medication. While these can be useful in the short term, they shouldn’t be used as a substitute for proper rest and rehabilitation. If you’re relying on medication to get through the day, that’s a sign that your tendon isn’t getting the proper recovery it needs.
For more severe cases, your doctor might recommend a corticosteroid injection to help reduce inflammation. However, this is usually a last resort and typically not the first-line treatment for Achilles tendonitis, as steroids can weaken the tendon over time.
5. Stretching and Strengthening Exercises
Once the initial pain and swelling start to subside, gentle stretching exercises can help improve flexibility in the tendon. This is one of the most effective ways to prevent future flare-ups. Achilles tendonitis often arises due to tightness in the tendon and calf muscles, so stretching them regularly can go a long way in preventing the injury from recurring.
I usually suggest a programme of eccentric strengthening exercises. This type of exercise involves slowly lowering the body (or the heel) in a controlled motion, which has been shown to strengthen the tendon and improve its function. A common exercise involves standing on a step with your heels hanging off the edge, then slowly lowering your heels below the level of the step and returning to starting position.
For patients recovering from Achilles tendonitis, I often emphasise the importance of patience. These exercises should be done consistently over weeks or months, not just until the pain goes away. It’s tempting to rush back into normal activity, but proper strengthening ensures that the tendon won’t get re-injured.
6. Shockwave Therapy (ESWT)
For patients who have been dealing with persistent Achilles tendonitis that doesn’t seem to improve with the usual treatments, shockwave therapy might be worth considering. This non-invasive treatment involves using high-energy sound waves to stimulate healing within the tendon.
In my clinic, I’ve seen success with shockwave therapy in cases that weren’t responding to traditional methods like physical therapy or anti-inflammatory medications. Shockwave therapy is thought to promote blood flow to the area and trigger a natural healing process.
It’s a treatment that’s becoming more common for musculoskeletal injuries, and while it’s not suitable for everyone, it can be a good option for those looking for an alternative to surgery.
7. Surgery (Last Resort)
Surgery is typically a last resort for Achilles tendonitis, reserved for cases where conservative treatments fail to provide relief or if there is a tendon tear or rupture.
The goal of surgery is to remove any damaged tissue and repair the tendon to allow it to heal properly. I’ve only seen a handful of cases where surgery was needed, and these patients were often those who had ignored their symptoms for far too long. Thankfully, surgical intervention isn’t necessary for most people, and recovery times can be quite lengthy, so I always encourage my patients to explore the non-surgical treatments first.
Prevention of Achilles Tendonitis
Preventing Achilles tendonitis is always better than treating it. With the right precautions, you can avoid the pain and hassle of this injury altogether. In my practice, I encourage my patients to focus on the following strategies to help keep their Achilles tendons healthy:
1. Gradual Increase in Activity
If you’re increasing your exercise intensity or trying a new activity, do so gradually. Your tendon needs time to adapt to new stresses, so avoid sudden increases in intensity, especially with high-impact activities like running or jumping.
2. Stretching and Warm-Ups
Before engaging in any physical activity, make sure you’re properly warmed up. Stretch your calves and Achilles tendons to keep them flexible and strong. After exercise, spend some time stretching again to keep the tendon from tightening up.
3. Cross-Training
To reduce the repetitive strain on your Achilles tendon, I often recommend cross-training. For example, if you’re a runner, consider mixing in cycling, swimming, or strength training. This helps to distribute the workload across different muscles and tendons, giving your Achilles tendon a break.
4. Proper Footwear
Worn-out or improper footwear can contribute significantly to Achilles tendonitis. Make sure your shoes provide proper support, especially if you’re engaging in activities that put a lot of strain on the tendon. If you’re an athlete, you may want to consider using orthotic insoles for added support.
5. Weight Management
Excess body weight can increase the load on your Achilles tendon. Maintaining a healthy weight not only reduces the strain on your tendon but also promotes overall joint and tendon health.
Achilles tendonitis can be a frustrating and painful condition, but with the right approach, it’s entirely manageable. Whether you’re experiencing the first signs of Achilles pain or you’ve been dealing with it for a while, remember that early intervention is key. Rest, rehabilitation, and the right treatments can have you back on your feet in no time.
Prevention is always the best strategy, so be sure to listen to your body, take care of your feet, and gradually build up your physical activity. If you do experience symptoms of Achilles tendonitis, don’t hesitate to get the help of a podiatrist who can guide you through a treatment plan that suits your needs.
