Do you have pain in the back of your heel?  Maybe a bump in that area that is killing you in shoes?  Is the pain worse after you train or exercise or even in the morning when you wake up?  You may have Achilles tendonitis.  This is a common problem in runners, basketball or soccer players.  It can even be brought on by certain minimalist shoes or even (GASP!) heels. 

What is Achilles tendonitis?

It is an inflammation of the large tendon in the back of the ankle.  It is caused by overuse, repetitive motion (such as running) or even shoes ( heels!).  This usually presents as pain and swelling at the back of the heel or ankle and is worsened by activity and with the first few steps in the morning.  

Causes of Achilles Tendonitis

The most common causes of Achilles tendonitis are:
  • Tightness of heel cord
  • Overpronation
  • Over training
  • Too much speed or hill work
  • Increasing mileage or practice time too quickly
  • Switching to a lower heel-toe drop too fast
  • Wearing heels
  • Haglund's deformity (bump at the back of your heel bone which is irritating your tendon) 

Unfortunately as we age our likelihood of Achilles tendonitis increases as our tendons become tighter and our bodies become less flexible.  It is because this lack of flexibility that we can no longer "bounce back". 

What will my symptoms be? 

The main complaint associated with Achilles tendonitis is pain behind the heel. The pain can be right at the heel bone called the calcaneys, the insertion of the tendon,  but is often most prominent in an area about 2-4 centimeters above where the tendon attaches to the heel. This area is called the watershed area and has a tenuous blood supply.

The pain is usually worst after exercise and can also be present when first walking in the morning and when getting up after sitting for long periods of time. Occasionally, pain will be felt with activity, such as running or jumping.  This is the most worrisome pain as it can signal impending rupture of the tendon. 

How do you treat it? 
Treatment of Achilles tendonitis begins with a thorough examination and x-rays.

X-rays may be normal, but may also show an extra bone.  It is an important test to determine prognosis.  Occasionally, an MRI is needed to evaluate a patient for tears within the tendon. 

A period of rest may be required or simply decreasing your training.  We often place patients in braces that stabilize and decrease swelling around the tendon.  We also consider ice, anti-inflammatory medication, and physical therapy. 

In particularly difficult cases a period of immobilization by cam walker or cast may be necessary.  While most people improve with conservative care, failure to respond may lead to surgery. 

What if I don't treat it?
Achilles tendonitis can progress to Achilles tendinosis.  This is a chronic degeneration of the 
tendon that can lead to tears of the tendon.  
Dr. Misty McNeill
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D.P.M. - Founder of Prairie Path Foot and Ankle Clinic