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What Is the Achilles Tendon?
A tendon is a band of tissue that
connects a muscle to a bone.
The Achilles tendon—the longest
tendon in the body—runs down the
back of the lower leg and connects
the calf muscle to the heel bone. Also
called the “heel cord,” the Achilles
tendon facilitates walking by helping
to raise the heel off the ground.
Achilles Tendonitis and
Achilles Tendonosis
Two common disorders that occur in
the heel cord are Achilles tendonitis
and Achilles tendonosis.
Achilles tendonitis is an inflammation
of the Achilles tendon. This
inflammation is typically short-lived.
Over time the condition usually
progresses to a degeneration of the
tendon (Achilles tendonosis), in
which the tendon loses its organized
structure and is likely to develop
microscopic tears. Sometimes the
degeneration involves the site where
the Achilles tendon attaches to the
heel bone. In rare cases, chronic
degeneration with or without pain
may result in rupture of the tendon.
Symptoms
The symptoms associated with Achilles
tendonitis and tendonosis include:
• Pain—aching, stiffness, soreness,
or tenderness—within the tendon.
This may occur anywhere along
the tendon’s path, beginning with
the narrow area directly above the
heel upward to the region just
below the calf muscle. Often pain
appears upon arising in the
morning or after periods of rest,
then improves somewhat with
motion but later worsens with
increased activity.
• Tenderness, or sometimes
intense pain, when the sides of
the tendon are squeezed. There is
less tenderness, however, when
pressing directly on the back of
the tendon.
• When the disorder progresses
to degeneration, the tendon may
become enlarged and may develop
nodules in the area where the
tissue is damaged.
Causes
As “overuse” disorders, Achilles
tendonitis and tendonosis are
usually caused by a sudden increase
of a repetitive activity involving
the Achilles tendon. Such activity
puts too much stress on the tendon
too quickly, leading to micro-injury
of the tendon fibers. Due to this
ongoing stress on the tendon,
the body is unable to repair the
injured tissue. The structure of the
tendon is then altered, resulting in
continued pain.
Athletes are at high risk for
developing disorders of the Achilles
tendon.Achilles tendonitis and
tendonosis are also common in
individuals whose work puts stress
on their ankles and feet, such as
laborers, as well as in “weekend
warriors”—those who are less
conditioned and participate in athletics
only on weekends or infrequently.
In addition, people with excessive
pronation (flattening of the arch)
have a tendency to develop Achilles
tendonitis and tendonosis due to the
greater demands placed on the tendon
when walking. If these individuals
wear shoes without adequate stability,
their over-pronation could further
aggravate the Achilles tendon.
Diagnosis
In diagnosing Achilles tendonitis or
tendonosis, the surgeon will examine
the patient’s foot and ankle and
evaluate the range of motion and
condition of the tendon. The extent of
the condition can be further assessed
with x-rays, ultrasound, or MRI.
Treatment
Treatment approaches for Achilles
tendonitis or tendonosis are selected
on the basis of how long the injury
has been present and the degree of
damage to the tendon.
In the early stage, when there is
sudden (acute) inflammation, one or
more of the following options may
be recommended:
• Immobilization. Immobilization
may involve the use of a cast or
removable walking boot to reduce
forces through the Achilles tendon
and promote healing.
• Ice. To reduce swelling due to
inflammation, apply a bag of ice
over a thin towel to the affected
area for 20 minutes of each waking
hour. Do not put ice directly
against the skin.
• Oral medications. Nonsteroidal
anti-inflammatory drugs (NSAIDs),
such as ibuprofen,may be helpful in
reducing the pain and inflammation
in the early stage of the condition.
• Physical therapy. Physical therapy
may include strengthening exercises,
soft-tissue massage/mobilization,
gait and running re-education,
stretching, and ultrasound therapy.
If non-surgical approaches fail to
restore the tendon to its normal
condition, surgery may be necessary.
The foot and ankle surgeon will select
the best procedure to repair the tendon.
Prevention
To prevent Achilles tendonitis or
tendonosis from recurring after surgical
or non-surgical treatment, the foot
and ankle surgeon may recommend
strengthening and stretching of the
calf muscles through daily exercises.
Wearing proper shoes for the foot type
and activity is also important in preventing
recurrence of the condition. ▲
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