Achilles tendonitis is the inflammation of the Achilles tendon – the tough sinew that attaches the back of the calcaneus (heel bone) to the calf muscle. Although the tendon is only approximately one-centimeter thick, its attachment spreads over a three and a half centimeter area on the calcaneus. Achilles tendonitis causes swelling and pain, leaving the tendon tender with pain when rising up on the toes or stretching the tendon. It also limits the range of motion of the ankle.

Causes

Overuse of the tendon, excess uphill running and a sudden increase in the intensity of training accompanied by switching between different types of shoes (eg running shoes and high heels) exert rapid stress on the Achilles tendon when it is inflamed and can result in Achilles tendonitis.

Symptoms

Symptoms of Achilles tendonitis include:

    • Pain and stiffness along the Achilles tendon in an area about two to four centimeters above where the tendon attaches to the heel
    • Pain along the tendon or back of the heel which worsens with activity
    • Severe pain a day after exercising
    • Thickening of the Achilles tendon. The thickening is partly as a result of bone spurs that may develop on the back of the calcaneus which can then grow up into the substance of the Achilles tendon, causing further wear and tear of the tendon
    • Bone spur/insertional tendonitis (a bone spur, also called an osteophyte, is a bony growth formed on normal bone, and is usually smooth, but can cause wear and tear or pain if it presses or rubs on other bones or soft tissues such as ligaments, tendons, or nerves in the body)
    • Swelling that is present all the time and worsens throughout the day with activity
    • When you experience a sudden “pop” in the back of your calf or heel you may have ruptured your Achilles tendon. See your doctor immediately.

Treatment

    • Rest is the most important treatment. Switch your exercise activity to something that does not put stress on the tendon
    • Wear a heel pad or shoe insert that will assist your foot to remain in the correct position for walking or running
    • It may be necessary to undergo physical therapy such as ultrasound, massage, stretching and strengthening exercises
    • Take non steroidal anti-inflammatory drugs to decrease inflammation and ease the pain.

Should these treatments not suffice, surgery is usually recommended. The surgical procedures performed are determined by the underlying problem, for example, when the bone on the back of the heel is very prominent and digs into the Achilles tendon, the bone is trimmed and shaved or the tendon may need to be repaired if there is tearing of the tendon where it attaches to the bone. A transfer of a tendon is used (the tendon of the big toe is transferred) which adds strength and support to the damaged tendon.

Prevention

    • Be sure to take time to warm-up and cool down properly before and after training
    • Wear footwear that is comfortable and fit your foot well and never use shoes beyond the recommended duration
    • Gradually incorporate hill work, speed, stairs and distance to your exercise routine and stretch regularly to strengthen the calf muscles.

Our Employee Wellbeing Programme (EAP) is available 24 hours a day if you want to know more about Achilles tendonitis.