The Achilles tendon connects the gastrocnemius and the soleus muscles (your calf muscles) to the calcaneus (heel bone). The role of tendons is to attach muscle to bone. The Achilles tendon is the thickest tendon in the human body and can withstand forces up to 1000 pounds. Achilles tendonitis is an inflammation of the Achilles tendon usually seen in runners (6.5-18%) and those individuals who participate in sports such as soccer, basketball, tennis, and dance. The Achilles
tendon has an area approximately 4 cm long in the middle 1/3rd of the tendon that has reduced blood flow, making it more susceptible to injury and rupture.
Typically, this type of tendonitis can occur due to overtraining, including increased duration, intensity, and frequency. Studies have demonstrated that up to 75% of the Achilles tendonitis cases occurred due to overtraining. Overtraining leads to more calf muscle fatigue, depletion of glycogen stores, and propensity to stretch, causing micro-tears in the tendon. Biomechanical factors, such as tibia varum (bow-legged), abnormal foot mechanics, weak hip musculature with a decreased in pelvis and thigh stability, and tight hamstrings and calf muscles can also be contributing factors in Achilles tendinitis.
Changes in activity levels, such as rapidly increasing running speed and mileage, adding hills and stair climbing to a training routine, and trauma caused by a sudden hard contraction of the calf muscle during activities like a sprinting or jumping are causative factors of Achilles tendonitis. Ruptures can also occur, but are usually associated with trauma by an explosive force of the calf muscle on the tendon when the tendon is inadequately warm or not in an optimal position for a hard, quick movement.
Symptoms associated with Achilles tendonitis can include mild soreness after an exercise that gradually worsens, episodes of diffuse or localized pain along the tendon, stiffness that reduces with warm up, swelling, and tenderness in the tendon above the heel. Due to several other conditions that may affect the same area, such as calcaneal bursitis or a partial tear in the tendon, proper diagnosis is important, so consulting with an orthopedist or physical therapist is essential. Treatment options for Achilles Tendonitis include:
1. Rest. Stop running or sports that require jumping and cutting to allow for the
inflammation to reduce for approximately 1 week.
2. Ice the area where you feel the most tenderness or discomfort during activity for 10-15 minutes several times a day, especially after activity.
3. Pain free stretching to the calf muscles, both the gastrocnemius and soleus for 30 seconds 3 repetitions several times per day.
4. Decrease time wearing high heeled shoes. High heels place your heels a lot higher than the toes, which can shorten the calf muscle. *Wearing a small heel (1 inch) can decrease the stress on the tendon and may help initially.
5. Massag the calf muscle to increase blood flow and decrease tightness in the muscle and tendon tissue.
6. Make sure you are in proper running shoes that are appropriate for your foot type. Consult your physical therapist or physician.
***If your symptoms have not resolved in a week or two with the above treatment options,
and you are continuing with pain with your normal daily activities, see a physical therapist for a
detailed evaluation and treatment plan.