Achilles tendinitis (Back of the Heel Pain)

Overview:

Achilles tendinitis is an overuse injury affecting the Achilles tendon, which connects the calf muscles to the heel bone.

This condition is frequently seen in runners who have abruptly increased their running intensity or duration. It also commonly affects middle-aged individuals who engage in sports like tennis or basketball only on weekends.

Most cases can be managed with simple at-home care under a doctor’s guidance. Self-care is crucial to prevent recurrence. However, severe cases may result in tendon tears (ruptures) that could require surgical intervention.

Causes

Achilles tendinitis occurs due to repetitive or intense strain on the Achilles tendon, which links your calf muscles to your heel bone. This tendon is engaged when you walk, run, jump, or push up on your toes.

As we age, the Achilles tendon becomes more prone to injury, especially for those who engage in sports only on weekends or have abruptly increased their running intensity.

Symptoms

Pain from Achilles tendinitis usually starts as a mild ache in the back of the leg or above the heel following running or other sports activities. More severe pain can occur after extended periods of running, stair climbing, or sprinting.

You might also notice tenderness or stiffness, particularly in the morning, which generally gets better with light activity.

Risk factor:

Several factors can elevate your risk of developing Achilles tendinitis:

Sex: Men are more commonly affected.

Age: The risk increases with age.

Physical issues: A naturally flat foot arch, obesity, and tight calf muscles can put extra strain on the Achilles tendon.

Training habits: Running in worn-out shoes, running in cold weather, and running on hilly terrain can all increase the risk.

Medical conditions: Conditions like psoriasis and high blood pressure can raise the risk.

Medications: Certain antibiotics, such as fluoroquinolones, are linked to higher rates of Achilles tendinitis.

Imaging

• X-rays: Although X-rays can’t show soft tissues like tendons, they can help rule out other conditions with similar symptoms.

• Ultrasound: This technique uses sound waves to visualize soft tissues, including tendons. It can provide real-time images of the Achilles tendon in motion, and colour-Doppler ultrasound can assess blood flow around the tendon.

• Magnetic Resonance Imaging (MRI): MRI machines use radio waves and a strong magnet to create highly detailed images of the Achilles tendon.

Prevention

While preventing Achilles tendinitis might not be entirely possible, you can take steps to lower your risk:

• Gradually increase activity: If you’re new to exercising, start slowly and progressively increase the duration and intensity of your workouts.

• ·Take it easy: Avoid activities that put excessive strain on your tendons, like hill running. Warm up with slower exercises before engaging in strenuous activities. If you feel pain during an exercise, stop and rest.

• Choose the right shoes: Wear shoes that provide good cushioning for your heel and firm arch support to reduce tension on the Achilles tendon. Replace worn-out shoes, and if your shoes are in good condition but lack support, consider using arch supports.

• Stretch daily: Stretch your calf muscles and Achilles tendon every morning, before and after exercise, to maintain flexibility. This is crucial to prevent a recurrence of Achilles tendinitis.

• Strengthen your calf muscles: Strong calf muscles help the calf and Achilles tendon handle the stresses of activity and exercise better.

• Crosstrain: Alternate high-impact activities like running and jumping with low-impact activities such as cycling and swimming.

Treatment

Typically, the initial treatment involves a multifaceted approach, which may include a combination of rest (either complete or modified activity), medication (such as NSAIDs or corticosteroids), orthotic interventions (like heel lifts, changing shoes, or correcting misalignments), along with stretching and strength training.

Pain interventions: Interventional treatments include percutaneous needle tenotomy, high-volume image-guided injection (HVIGI), tendon scraping, vacuum debridement, Ortho biologic injectable therapies such as platelet-rich plasma (PRP) and mesenchymal stem cells and Corticosteroid injections.

You can always contact Dr Chinmoy Roy at Rajarhat pain clinic at Newtown, Kolkata for best treatment options in a case of tendinopathy or tendon tear.