If you are active in sports, you may have experienced discomfort or soreness in your Achilles (uh-KIL-eez) tendon at one time or another, or you may have heard one of your friends complain about Achilles tendonitis. The Achilles tendon connects the large calf muscles to the back of your heel. If you trace your finger along the back of your leg staring at the heel and moving upward toward the knee, you will appreciate both the Achilles tendon as well as the calf muscles, which pull on it from above.
What causes Achilles tendonitis?
The Achilles tendon allows you to rise up on your toes, as well as push off from the ground. This tendon is thus crucial for standing, walking, running and jumping. Repeated and continuous exertions can lead to small injuries, or micro-tears, in the tendon. If the Achilles is not given time to rest or if the micro-tears have trouble healing, the tendon can become inflamed and sore. This inflammation is referred as Achilles tendonitis.
While Achilles tendonitis certainly can affect professional athletes, it is more likely to afflict amateur athletes and commonly is seen in runners who have recently started increasing the intensity and duration of their running, like during marathon training. People with sedentary work styles may also encounter tendonitis when they participate in occasional but strenuous athletic activities like basketball, soccer or tennis.
Achilles tendonitis affects about 1 in 5,000 people at any time, and while it can occur in people of all ages, it most commonly can be found in people between the ages of 30 and 50. Some of the common symptoms of Achilles tendonitis include cramping, tightness, pain and stiffness along the back of the calf and lower leg in the morning, pain along the back of the heel that worsens with activities, thickening of the Achilles tendon itself and severe pain after exercise.
“Around January and February, we see a lot of runners training for the Boston Marathon, coming in with running related problems, and Achilles Tendonitis is one of the most common,” recounts Dr. Holly Johnson, Foot & Ankle Orthopaedic Surgeon at the Massachusetts General Hospital Department of Orthopaedic Surgery. “By resting, cross-training and conservative treatment, they can usually get back to their training,”
Treatment
You can effectively treat Achilles tendonitis on your own. It involves rest, stretching and physical therapy.
- Resting the Achilles tendon from activities that cause pain is important. At the very least you need to reduce the intensity of the workouts, and preferably take a break from the activity for 2-5 days.
- Consider cross-training to maintain fitness levels. If you participate in high-impact activities like running, basketball or tennis, switch to a low-impact activity like biking, swimming or using the elliptical machines.
- Consult with an athletic trainer or physical therapist as necessary to check if your form and techniques are correct. They may pin-point specific deviations from correct form, which could have caused the injury.
- Stretch the calf muscles. Simple exercises like calf stretches and heel drops help to relieve the pain and improve flexibility. Work with an athletic trainer to improve strength of the quadriceps and hamstring muscles. Many people find relief with using a foam roller.
- Use ice to soothe pain and soreness after a workout.
- Consider replacing your shoes if you are a runner.
Remember not to get back into high-impact activities too soon. If you have been avoiding high-impact activities, but the pain still persists beyond a few weeks, you should see a doctor.
Stretches & Exercises for Achilles Tendonitis:
“I had just started training for the 2014 Boston Marathon and felt a sudden pain in my Achilles tendon,” says Allison Downy from Boston, MA, looking to run her third Boston Marathon. “I knew if I didn’t take care of it right away it could potentially get worse and prevent me from running. I stopped running for a few days and instead worked out on low impact machines. I stretched and applied ice everyday and was able to continue back on my training schedule.” Allison successfully ran the Boston Marathon on April 21, 2014.
If Achilles Tendonitis is left untreated, it can be harder to treat, the tendon becomes inflamed, and the duration of pain and time to recovery increases. In rare cases refractory Achilles tendonitis requires surgical intervention.
“Achilles tendonitis is often very treatable. Proper care mandates a prompt protocol of rest and stretching. Patients should remember that recovery of Achilles tendonitis takes time. Graduated reintegration into activities is important to avoid re-injury” says Dr. Chris DiGiovanni, Chief of the Foot & Ankle Service at the Massachusetts General Hospital.
[cross-posting from AchesAndJoints.org]
Arun Shanbhag 
Hi Arun, my ortho specialist is over at the Watertown, harvardVanguard. He diagnosed me with achilles tendonitis in 2013. I was closely watched for almost 1 year with my Achilles tendonitis. We first started with a boot and inserts, had an MRI done then eventually moved up to p.t. Things got a little better, the boot came off! Soon after p.t. stopped, I continued with my exercises, and the pain came back anyway. Simply light walking ( less than 1 mile) can cause excruciating pain, not as much when stepping, but when picking up my foot to take the pressure off, the throbbing is insane! So we went back to wesring that damn boot. I used to be the fast Walker, now I cannot keep up with my husband. I returned to my Ortho., he is a great guy, explains things thoroughly. As a last resort, he suggested acupuncture which was my “miracle cure”! I went for almost 1 year. The swelling went down, the pain was virtually gone! However, once my flex spending account had run out, I stopped going for acupuncture treatment because it is so expensive. Within 6 months (+/-) the pain slowly came back. I don’t know whether I should get a second opinion from a Doctor, or go back to my Ortho specialist, then get a second opinion from a doctor to be sure it has been diagnosed properly. The initial MRI showed severe swelling near the heel and he suspected possible mini-tears. He concluded I’m just the 1% that will need surgery because of the returning pain. That was almost 1 year ago. Now the throbbing pain occurs even while I’m lying in bed or after sitting for more than 15-20 minutes (like at lectures). The first few minutes I put pressure on it I walk with a severe limp, then it loosens up. Sometimes I have to do several ankle circles for a “pop” to occur and everything seems “back to normal” meaning minimal pain rather than immobility and exaggerated limping.
What would you suggest the next step be Arun, what is your opinion for a treatment plan? Thoughts anyone? I am soon changing careers and will be doing a more physically demanding job requiring me to be outdoors on my feet for many hours (which I prefer) but want to take care of this ankle. If surgery is part of that care, I want to do it sooner than later to heal properly before beginning this new phase in our lives in our mid 40’s.
Thanks in advance,
Phoebe
Hi Phoebe,
Thank you for your very detailed email; and I am sorry for the difficulties you are having with your Achilles Tendon.
I strongly suggest that you see a different orthopedist to resolve your tendonitis.
Since you are in the Boston Area, may I suggest that you see one of our doctors Sorry, this seems like a plug for our docs, but not sure how best to refer you.
http://www.massgeneral.org/ortho-foot-ankle/
If you find the wait times are too long to see the surgeon, I suggest you ask to see one of our Advanced Practitioners. You can usually get an appointment in a day or two, and they work very closely with the surgeons and discuss all difficult cases. That is what I do 🙂 and if it is complex case, they get the surgeon to see you faster, internally.
Wishing you the best.
A
Thank you soooo much Arun!!!! Many many thanks! Not a plug for MGH at all. A co-worker at the preschool I work at is a Physical Therapist and looked at me so puzzled and I quote why would you go anywhere else other than a top rated Hospital in the entire country call MGH!” Thank you for the link as well,
Phoebe