Description

The Achilles tendon is the largest tendon in the body which connects the calf muscles to the heel. Achilles tendonitis is inflammation of the Achilles tendon at or near its attachment to the calcaneus or heel bone.

What are the causes?

Achilles tendonitis (insertional) may result from overuse, tight calf muscles, running or shoe wear.

What are the symptoms?

Patients complain of pain in the Achilles tendon near the heel. Swelling or a bump may be felt in or near the tendon. Patients may have pain while running, which may aggravate over time.

How is it diagnosed?

On physical exam, the surgeon will palpate the Achilles tendon, reproducing the pain. A swelling may be felt in or around the tendon. Imaging studies may show soft tissue changes in the posterior ankle. X-rays will show a bone spur in the back of the heel, which is called a Haglund’s deformity. To assess the degeneration of the tendon and size of the bursa, MRI may also be helpful.

How is it treated?

Non-operative

Your surgeon will suggest anti-inflammatory medications, heel lifts (to take stress off the tendon) and rest. Immobilization in a cast or walking boot may be offered for several weeks while the tendon heals. Physical therapy to stretch and strengthen the tendon may also be recommended.

Operative

Patients who fail non-operative treatment may be candidates for surgery. If the pain is located where the tendon attaches to the heel (calcaneus), the tendon is removed from the bone, the bone tissue interface is freshened (debrided) and the tendon is reattached. The bony prominence on the back of the heel causing the patient’s pain will be shaved down along with removal of the inflamed bursa. The patient is placed in a cast or splint and will be non-weight bearing for a period of time allowing soft tissues to heal. After an initial period of immobilization, physical therapy is started to regain strength and range of motion.