The body responds to injuries or diseases through inflammation. Thus, Achilles tendinitis is the body’s response to an injury in the Achilles tendon. This health issue is increasing in the US, from 1.8 in 2012 to 2.5 in 2016 per 100,000 people. Health professionals must understand several diagnostic and treatment options to handle this issue adequately and deal with its increasing incidence.

What is Achilles Tendinitis?

Achilles tendinitis is a health issue involving the inflammation and irritation of the Achilles tendon. This tendon connects the heel bone to the calf muscle at the back of the heel and is critical for walking, running, and jumping since it enables the heel to get off the ground.

The primary cause of Achilles tendinitis is running and jumping-related Achilles tendon stress or overuse. Repeated stress or overuse of the tendon gives the body limited time to repair injured tissues, leading to inflammation or irritation.

Patients with this condition experience significant pain. Left untreated over a prolonged period, Achilles tendinitis can result in long-term problems, such as walking difficulties. 

Types of Achilles Tendonitis

In light of the affected tendon part, non-insertional and insertional Achilles tendinitis are the two basic types of Achilles tendinitis. Patients with non-insertional Achilles tendinitis are conditions where the tiny tears in the middle fibers of your tendon start to break down. Non-insertional Achilles tendinitis is also when a patient experiences breakdown, swelling, or thickening of the fibers in the middle of the Achilles tendon; this tendonitis type is more common in younger and more active people. 

Conversely, patients with insertional Achilles tendinitis experience inflammation at the lower part of the heel where the tendon connects or inserts into the heel bone. Everyone, including non-active people, is susceptible to insertional Achilles tendinitis. However, the condition is common in people who overuse the tendon, especially long-distance runners. 

What is the Leading Cause of Achilles Tendonitis?

Achilles tendinitis occurs when the Achilles tendon is overused, swollen, irritated, and inflamed. It typically results from repetitive stress on the tendon rather than being injured outright, often caused by being active on your feet. The Achilles tendon is constantly in use, so the body does not have time to heal the injured tissue.

Symptoms of Achilles Tendonitis 

Some common symptoms of Achilles tendinitis include:

• Weakness of the leg
• Persistent heel and ankle pain
• Swelling around the Achilles tendon
• Increased stiffness or tenderness of the tendon
• Pain on the back of the heel when wearing shoes
• Pain worsens with physical activities
• Increased discomfort after climbing or walking uphill
• Morning discomforts at the Achilles tendon

Risk Factors of Achilles Tendinitis

People highly susceptible to Achilles tendinitis include:

• Sportsmen/women, especially in sports that require quick starts and stops
• Runners
• Dancers
• Laborers whose jobs excessively stress their feet and ankles
• Leisure sport participants (i.e., people who participate in sports less frequently)

Notably, the body's anatomy significantly affects susceptibility to Achilles tendinitis. Some body shapes and structures at high risk of this condition include:

• Flat arches
• Tight or weak calf muscles
• Overpronation (or ankles  that roll down and in when walking)
• Bone spur (or extra bone growth in the heel), which rubs the tendon to cause pain

Diagnosing Achilles Tendinitis

Diagnosing Achilles tendinitis includes a preliminary physical examination involving pressing the affected area to determine the location of pain, swelling, or tenderness. Professionals must also identify the presence of relevant signs and symptoms.

Moreover, health professionals must ascertain the patient's flexibility, range of motion, alignment, and reflexes of the foot and ankle. The ankle's limited range of motion is a sign of Achilles tendinitis, specifically when the patient exhibits a decreased ability to point toes downward.

In most cases, professionals require patients to carry out follow-up imaging tests to confirm that the identified symptoms are Achilles tendinitis-based and ascertain the severity of the condition.  These imaging tests include X-rays, ultrasound, and magnetic resonance imaging (MRI).

X-rays

X-rays are a form of electromagnetic radiation identical to visible light except at a higher energy. They can penetrate most objects and the human body and are used to make images of internal tissues and structures in medical settings. In this case, X-rays pass through the body and go to a detector on the other side, making an image of the 'shadows' of the objects inside.

X-ray imaging allows professionals to narrow down the conditions that can cause similar symptoms. Although this imaging test is unsuitable for visualizing soft tissues, such as tendons, it is ideal for diagnosing Achilles tendinitis.

Ultrasound

Ultrasound is a test in which high-frequency sound waves are used to create images of the inside of your body. Sound waves are transmitted and detected by a device called a transducer. Unique materials in the transducer produce these sound waves, as electricity applied to these materials generates waves. The waves hitting those boundaries between, say, fluid and bone bounce back up toward the transducer. The echo travels through the organs to the body's surface and back to the probe, where the ultrasound scanner calculates the distance and constructs a two-dimensional image of the organs and tissues.

Unlike X-rays, ultrasound can visualize tendons using sound waves. Moreover, professionals can obtain real-time images of the tendon in motion using this device and evaluate blood flow around the tissue using a more advanced color-Doppler variant.

‍Magnetic Resonance Imaging (MRI)

On an MRI, a powerful magnet creates a strong magnetic field that lines up the body's protons. Protons come out of alignment when a radiofrequency pulse is sent through the patient. After the pulse is turned off, the protons return to where they were, releasing energy. The MRI sensors detect this energy, but the time it takes to realign and the amount of energy given off differ, depending on the tissue type. They can then tell apart different tissues based on their magnetic properties.

MRI machines leverage radio and magnetic waves to produce highly detailed images of the Achilles tendon to identify inflammation or irritation. MRI is also essential for planning surgical procedures because it visually presents the severity of the tendon damage.

Treatment Options for Achilles Tendonitis

While self-care measures, such as wearing supportive shoes, avoiding extreme sports or activities, and muscle stretching, effectively address Achilles tendinitis, professionals can prescribe other surgical and nonsurgical treatment options. These treatment options include physical therapy, medications, and surgical procedures.

Physical Therapy

Physical therapy is a recurrent treatment option for Achilles tendinitis. Therapists may prescribe exercise or orthotic devices, depending on the severity of the condition. Stretching and strengthening exercises can significantly improve the tendon and its supporting structures. Eccentric strengthening, a form of physical therapy, can eliminate persistent Achilles tendinitis.

Therapists can also prescribe orthotic devices, such as shoe inserts or wedges, to slightly elevate the heel and relieve strain on the tendon. These devices can adequately minimize the force exerted on the Achilles tendon.

Medications

Anti-inflammatory and pain relief drugs, such as Advil, ibuprofen, naproxen, Motrin IB, and Aleve, can significantly improve the experience of a patient suffering from Achilles tendinitis.

Surgery

Professionals opt for surgical procedures when conservative and non-surgical options do not efficiently address Achilles tendinitis. The surgical procedures commonly involve repairing the Achilles tendon to eliminate the damage and promote healing.

Bottom Line

The Achilles tendon is susceptible to tear and injury due to excessive stress and overuse. While the condition is common in physically active people, non-active people experience it since their body systems are unaccustomed to certain stress levels. In addition to physical examination, professionals can order image tests, such as X-rays, ultrasound, and MRI, to adequately diagnose the presence of Achilles tendinitis. Moreover, the professionals can leverage surgical procedures and nonsurgical treatment options, such as physical therapy and medications, to address Achilles tendinitis.