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Achilles tendonitis is very common. The Achilles is the largest tendon in the body. It is used for various physical activities such as walking, running, sprinting and jumping. Achilles tendonitis occurs when the large tendon that runs from the calf to the heel bone becomes irritated and inflamed. The Achilles tendon can withstand great stress; however, it is particularly prone to develop inflammation, resulting in Achilles tendon pain. This pain most often occurs due to overuse and degeneration. Certain athletes, such as long distance runners and sprinters are at increased risk for Achilles tendonitis and even an Achilles rupture.

There are two types of Achilles tendonitis:

• Midsubstance or NonInsertional Achilles Tendonitis – Occurs in the middle portion of the tendon
• Insertional Achilles Tendonitis – Occurs where the large tendon connects to the heel bone

Symptoms of Achilles Tendonitis 

Common symptoms of Achilles Tendonitis may include: 

• Pain – Aching, stiffness, or soreness within the Achilles tendon. The pain may occur anywhere from the calf to the heel. Pain is likely to worsen with exercise or feel worse in the morning. 
• Tenderness – This can be moderate to potentially severe pain when the two sides of the tendon are squeezed versus directly touched. 
• Bone Spur (insertional tendonitis) – Nodule(s) behind the damaged tissue may form when the disorder progresses to degeneration. 
• Tendon Thickening – A noticeable thickening of the Achilles tendon. 

Causes or Risk Factors for Achilles Tendonitis 

Achilles tendonitis is generally not caused by a specific injury. It typically happens from repetitive stress on the Achilles tendon. Repetitive stress happens when a person pushes in an exercise or sport too much within a short amount of time, commonly known as an “overuse injury.” This puts too much stress too fast on the Achilles tendon. 

However, there are other risk factors that may cause Achilles tendinitis to develop, including: 

• Bone growth or spur – Extra bone growth where the tendon attaches to the heel, which can rub against the tendon and cause pain. 
• Tight calf muscle(s) – Having tight calf muscles to begin with and abruptly starting an aggressive exercise program. 

Treatment Options for Achilles Tendinitis 

The good news is that there are several non-surgical treatment options for Achilles tendonitis: 

• Immobilization – May include the use of a cast or removable brace that will help with healing. 
• Ice – Applying ice for 20 minutes on and off may help to reduce the inflammation and swelling of the Achilles tendon. 
• Medications – Oral medications such as nonsteroidal anti-inflammatory medications (NSAIDs) are useful in reducing swelling and inflammation. 
• Shoe Orthotics or Inserts – These may be helpful, especially for those who suffer from overpronation of the foot. This is caused by gait abnormalities or uneven body weight distribution pressing down on the foot. 
• Night Splints – These may be used at night to maintain a stretch in the Achilles tendon during sleep, helping to decrease the common morning pain associated with Achilles tendonitis. 
• Physical Therapy (PT) – Stretches and exercises focused on rehabilitation of the Achilles tendon. 
• Platelet-Rich Plasma or Stem Cell Injections – A newer treatment option that can assist in decreasing the inflammation and reboot the healing phase using the body’s own platelets. 

Surgical Treatment Options for Achilles Tendonitis & Achilles Rupture 

If non-surgical treatment options have been exhausted, surgery to repair the tendon may be considered. The operation chosen may depend on the extent of the condition, as well as the person’s age, activity level and overall goals. 

Surgery and Immobilization for Achilles Rupture When the Achilles ruptures, often due to overstretching of the Achilles tendon, surgery is typically needed to repair the ruptured tendon. However, immobilization is also a common treatment option, where a cast, splint, brace, walking boot, or other device keeps the lower leg and ankle from moving. This allows for the ends of the Achilles tendon to reattach and heal. While surgery and immobilization are often very successful options for a ruptured Achilles, another rupture is less likely after surgery versus immobilization. 

Surgery for Midsubstance or Noninsertional Achilles Tendonitis 

For midsubstance or noninsertional Achilles tendonitis, surgery will focus on removing the bad portion of the tendon. If the tendon is damaged, a surgeon will often use the tendon that goes to the big toe to support the Achilles tendon. If the Achilles tendon or calf muscles are too tight, surgery may also focus on lengthening them. 

Surgery for Insertional Achilles Tendonitis 

In this surgery, diseased tissue is often removed. The tendon is then repaired back down to the heel bone. The surgeon may shave down the bone spur and smooth it out. This prevents the bone spur from rubbing the Achilles tendon and irritating it. Often a fluid- filled sac called a “bursa” is a contributing factor to pain and inflammation. In these cases, the bursa is removed during surgery.