Typically there is pain at the back of the heel after sport or other activity. The symptoms of Achilles tendinitis start as a mild pain that gets gradually worse over a period of time. The tendon is thickened and sore to touch.
The affected area tends to feel particularly stiff after long periods of rest. You may therefore feel stiffness particularly with first steps after waking up in the morning, or after sitting for a long time. The stiffness tends to improve once you are moving. The pain may increase during or after running or other physical activities. You may feel severe pain in your Achilles tendon on a day following exercise.
As well as the pain, common symptoms include swelling, tenderness, tight muscles and limited ability to flex the foot. Inflammation can also cause your foot to feel very warm. In some cases, you may even see a small hard lump, or ‘nodule’, on the back of your ankle.
The condition develops when the Achilles tendon becomes inflamed and swollen. This does not typically occur as the result of any particular injury, but rather as the result of putting too much stress on the tendon and partly though natural aging. It is therefore often associated with playing sports intensely or not stretching well before sport. The condition is common amongst runners.
Usually the pain is in the middle of the tendon. The condition normally occurs at either the middle of the tendon, which is known as ‘mid-substance Achilles tendinitis’, or where the tendon joins the heel bone, which is called ‘insertional Achilles tendinitis’. This is less common and seen in people with a prominent shaped heel bone that causes rubbing against the tendon, damaging it and causing pain.
If your calf muscle is tight and not properly stretched out before performing a physical activity, you are also putting yourself at risk of suffering from Achilles tendinitis. To avoid Achilles tendon problems, it is very important to take the time to warm up before exercise. If you are a runner, avoid suddenly running significantly longer distances than usual.
Footwear can also be a factor involved in Achilles tendinitis. For instance, if you do not wear shoes with adequate support while running or playing sports. Suddenly changing to “barefoot” running can precipitate Achilles tendon problems.
Most of the time, nonsurgical treatments will be recommended by your doctor to treat Achilles tendinitis. If your symptoms do not improve, surgery will be the next option.
Achilles tendinitis usually gets better over 12 or 18 months. We will recommend that you avoid any activities that stress your ankle and that you rest. If you wish to continue playing sports, we will recommend that you switch to low impact activities such as swimming or cycling.
Your specialist will suggest a series of different activities aiming to reduce the stress on your Achilles tendon and stretch your calf muscle. You may also need to wear special footwear that supports your ankle better.
Physiotherapy is very effective in treating the condition. Our specialist physiotherapists will guide you and recommend the treatment best fitted to your specific case.
If physiotherapy fails to improve the problem then an ultrasound scan will help your specialist to decide whether shockwave treatment or modern injection therapy is the next step.
Surgical procedures are generally recommended only if the condition does not improve with non-surgical treatments, or if the damage to the tendon is severe. The type of surgery necessary will depend on the location and the extent of the injury.
For mid-substance tendonitis, the foot and ankle surgeon will remove any damaged tissue. With insertional tendonitis, the prominent bone and damaged tissue will be removed. If your condition is severe the surgeon may transfer a tendon from another part of the ankle.
The recovery period can vary greatly from patient to patient, depending on the extent of their injury. All patients will require several months of physiotherapy during the rehabilitation period.