What is Achilles tendonitis? It is an overuse injury of the Achilles tendon which inserts on the back of the heel bone.    This condition is a result of improper biomechanics, whereby the structure of the foot places strain on the tendon during walking and running.  When irritated, the tendon becomes inflamed.  Some people are more predisposed to Achilles tendonitis than others.  It commonly occurs in people who increase their level of activity quickly and also can present in women after chronic use of high heels.  A lack of appropriate stretching makes the tendon functionally shorter and this results in rapid stretch of the tendon when not wearing shoes with heel lift or when barefoot.

How is this treated?  Because the condition is comprised of inflammation and poor foot mechanics, both of these need to be addressed for treatment.

  • First appointment: At your first appointment, your doctor will examine your feet and take x-rays of the painful foot to rule out other causes of pain and also to assess if there is a bone spur present.  If you are diagnosed with Achilles tendonitis, there are two main causes to your condition that need to be addressed.
    • Inflammation: This is what causes the tendon to be painful.  Inflammation can be managed with oral non-steroidal anti-inflammatories, icing, and in some cases topical anti-inflammatory medicines.  These methods are typically needed only in the first few weeks of treatment.
    • Biomechanics: The predisposing factor in Achilles tendonitis is when the heel is not properly aligned and when the Achilles tendon has not been stretched routinely.
      • Stretching: Your doctor will provide you with instructions on stretches to perform that reduce the tightness of the Achilles tendon.  These stretches should become habit to prevent recurrence of Achilles tendonitis.
      • Night Splint: These devices are especially useful in cases of Achilles tendonitis because it stretches the tendon while you sleep.
      • Bracing: Ankle braces provide additional support to allow the Achilles to rest while healing.  Your doctor carries exceptional bracing options that are not available over the counter.  Walking boots may also be required depending on the severity of your condition.
  • At your first follow-up: Your doctor will re-assess your condition and determine what the next step needs to be. 
    • If your condition is nearly 100% improved the focus of treatment is to prevent recurrence of the condition.  When the acute pain is reduced, this tells us that your inflammation has nearly completely resolved.  This places our focus next onto ensuring that biomechanics are corrected and that your heels and feet are kept in a neutral position with good alignment of the heel. 
      • Custom orthotic inserts allow optimal support of your heels and feet to prevent further strain on the Achilles tendon.  If custom orthotics are recommended to you at your follow-up the next step is an appointment  with our highly trained staff to obtain an impression of your feet.
    • If your condition has not improved or only improved slighly, this tells your doctor that the next step will be implementation of additional therapies.
      • Physical Therapy: In some instances, the at-home stretching , anti-inflammatories and icing are not completely effective in reducing inflammation and alleviating Achilles tendonitis.  In tougher cases, physical therapy can be the key to getting better.  There are various techniques provided by physical therapists in your area that can help get on the road to healing.
    • If things still aren’t improving: If you have stubborn achilles pain even after the above mentioned treatment, your doctor will re-assess you to determine the next course of treatment.
      • Traumeel: Traumeel is a natural, homeopathic medicine that is used in relieving musculoskeletal pain.  This medicine is available in many formulations (topical gel, topical ointment, oral tablets and oral drops)and is often used in place of NSAIDS like ibuprofen. 
      • EPAT: Extracorporeal Pulse Activation Technology or EPAT is a treatment that transmits a wave of pressure to a painful area, increasing circulation and stimulates regeneration of damaged tissue.
      • Amniofix: This is a new option in the treatment of multiple overuse injuries, including Achilles tendonitis.  This option uses the technology of micronized amniotic membrane which reduces inflammation and provides growth factors to the tendon to heal the damaged tissue.  This injection can be painful a few days following its administration, but has been shown to effectively treat Achilles tendonitis that has been resistant to more traditional therapies.
      • Further Studies such as obtaining an MRI, diagnostic ultrasound or CT scan of the ankle is sometimes necessary to ensure that there are no tears or damaged tissue within the Achilles tendon.  These findings do not typically show up on x-ray.
      • Surgery: Surgery is an option in some instances of chronic Achilles tendonitis, especially if there is a bone spur present.  Surgical options include lengthening of the tendon and reconstruction of the tendon after removing damaged tissue and bone spurs (if present).

As you can see, Achilles tendonitis is a multifaceted diagnosis which requires strict adherence to at home therapies, as recommended by your doctor.  It can be a very difficult condition to resolve, but there are many treatments available to ensure that you get back to your regular activities without pain.


Dr. Misty McNeill
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D.P.M. - Founder of Prairie Path Foot and Ankle Clinic