Achilles Tendonitis

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Diagnosis

Diagnosis of Achilles tendonitis usually involves taking a patient history, and performing a physical examination and imaging tests (e.g., x-ray, ultrasound). Patient history includes the following:

• History of prior pain or weakness in the lower leg
• History of recreational activity
• Recent changes in activity level, footwear, or training duration or surface

Physical examination involves palpating (i.e., feeling with the fingers) the lower leg for tenderness, swelling, nodules, warmth, and decrease in mass (atrophy). The doctor also measures active and passive range of motion of the knees, ankles, and feet, and determines the resting alignment of the ankles and feet.

A Thompson test is performed to detect rupture of the Achilles tendon. In this test, the patient lies face downward on the examining table with bent knees and the doctor squeezes the back of the lower leg (calf). If the Achilles tendon is at least partially intact, this test causes the foot to flex.

Imaging tests that may be used to help diagnose Achilles tendonitis include x-ray, ultrasound, and magnetic resonance imaging (MRI scan). X-rays cannot conclusively diagnose the condition, but they may be used to detect soft tissue swelling and heel bone calcifications (i.e., calcium deposits) or fractures.

Ultrasound may be used to detect thickening of the Achilles tendon. MRI scan can be used to detect partial tendon rupture and degenerative tendon changes.

Treatment for Achilles tendonitis depends on the severity of the injury. If heel pain, tenderness, swelling, or discomfort in the back of the lower leg occurs, physical activity that produces the symptoms should be discontinued.

If the problem returns or persists, a medical professional should be consulted. If pain develops even with proper stretching and training techniques, the patient should consult a podiatrist to check for hyperpronation and adequate arch support. The addition of an orthotic may be enough to maintain good arch and foot alignment and eliminate pain.

If damage to the tendon is minor, the injury may respond to a simple course of treatment known as RICE (rest, ice, compression, elevation).

Patients are advised to:

• rest the tendon by keeping off their feet as much as possible;
• apply ice packs for 20 minutes at a time every hour for a day or two to reduce swelling;
• compress the ankle and foot with a firmly (not tightly) wrapped elastic bandage; and
• elevate the foot whenever possible to minimize swelling.

A nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen may be used to reduce pain, swelling, and inflammation.

Additional treatment may be required if injury to the tendon is severe, if mild Achilles tendonitis does not respond to basic treatment, or if symptoms return with the resumption of physical activity.

A flexible cast may be used to immobilize the foot and reduce swelling, and crutches may be used to keep weight off the foot. This treatment may be necessary for up to 8 weeks.

If the injury responds to this treatment, the patient may then be advised to wear low-heeled shoes and perform rehabilitation exercises (e.g., physical therapy) to gradually stretch the tendon before full activity is resumed.

Severe Achilles tendonitis, tendon rupture, or tearing away from the heel bone may require surgery and lengthy rehabilitation. Surgery involves removing the tendon's inflamed outer covering and reattaching the torn tissues.

Following surgery, patients undergo passive range of motion physical therapy and progressive strengthening exercises for 2–3 weeks. Most activities can be resumed in 6–10 weeks and competitive sports usually can be resumed after 3–6 months.

Proper conditioning and appropriate footwear are the best defense against Achilles tendonitis. People who engage in physical activity should always warm up (e.g., jumping jacks, light jogging) and stretch properly before beginning the activity. Cold muscles are inflexible and working them hard without stretching causes excessive stress to the muscles and tendons.

If discomfort occurs, the activity should be discontinued immediately and ice should be applied to the affected area to relieve inflammation. If the problem persists or recurs, medical evaluation is necessary. It may be advisable to consult a physical trainer to determine whether a flaw in technique is contributing to the problem.

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