Achilles tendinitis is described as an overuse injury of the Achilles tendon, a band of tissue that connects the calf muscles at the back of the lower leg to your heel bone.
Achilles tendinitis is most common in runners who have suddenly increased the intensity or duration of their runs. It's also common in middle-aged people who play sports, such as tennis or basketball.
Most cases of Achilles tendinitis can be treated with relatively simple, at-home care. Self-care strategies are usually necessary to prevent recurring episodes. More-serious cases of Achilles tendinitis can lead to tendon tears (ruptures) that may require surgical repair.
Symptoms and Diagnosis
The pain associated with Achilles tendinitis typically begins as a mild ache in the back of the leg or above the heel after running or other sports activity. Episodes of more-severe pain may occur after prolonged running, stair climbing or sprinting.
You might also experience tenderness or stiffness, especially in the morning, which usually improves with mild activity.
If you have experienced a sudden "pop" in the back of your calf or heel, you may have ruptured (torn) your Achilles tendon. See your Achilles rupture guide if you think you may have torn your tendon.
Your doctor will ask you a few questions about the pain and swelling in your heel or calf. Your doctor may ask you to stand on the balls of your feet while they observe your range of motion and flexibility. The doctor also feels around (palpates) the area directly to pinpoint where the pain and swelling are most severe.
Imaging tests may help confirm Achilles tendonitis, but you usually don’t need them. If ordered, the tests include:
- X-rays, which provide images of foot and leg bones
- MRI scans, which can detect ruptures and tissue degeneration
- Ultrasounds, which can show tendon movement, related damage, and inflammation
The first steps of rehabilitation is to reduce any swelling and pain. This can be done using the rice principle (rest, ice, compression, elevation).
It is important that you start avoiding the activity that is aggravating the issue. Then apply ice to the area, you can do this several times a day when you have chance but only apply for 20 minutes at a time. Compression socks, heel pads and orthotic insoles can be introduced as well to help with this process.
Once the pain has settled and you are able to weight bare and walk without pain, you can start some strengthening and stretching exercises. It is important not to rush into progressions, if you start exercising too intensely too soon, you'll be back a square one. The injury can take anywhere from 2 weeks to 12 months to heal properly so make sure you take every step carefully.
Stretching and Strengthening Exercises
Two calf stretching and strengthening exercises in particular are important, one with a straight leg for the gastrocnemius muscle and one with the leg bent to target the soleus muscle. Stretching should be done regularly, three times a day initially and should be maintained long after the injury has healed to prevent the injury returning.
Gastrocnemius heel drop
- Stand with two feet on a step, with your heels hanging off the edge.
- Use both feet and perform a heel raise.
- Lift one leg so you are left balancing on one foot (You can use a wall for balance).
- Lower your heel and body down slowly until you feel a stretch in the calf/Achilles.
- Place your other foot back on the step and repeat.
- As soon as 2 x 15 repetitions, twice a day can be done pain free the load should be increased. This can be done by wearing a weighted vest or rucksack to increase the weight or load through the Achilles tendon.
Soleus heel drop - The more common stretch for the calf.
- Start by standing facing a wall.
- Put one leg in front of the other, with the leg to be stretched at the back.
- Bend the back leg and then lean forward against the wall, if you do not feel a stretch, place the rear foot further away from the wall.
- Hold for 15 seconds, relax and repeat 4 times.
Keep up these exercises until you are able to complete them without any discomfort and pain, at this point you may start introducing sport specific training again. It is advisable to continue these exercises as it will help with injury prevention for the future.