Achilles tendinitis is a very common injury of the lower extremities. It is most common among athletic patients, particularly runners.

The Achilles tendon connects the calf muscles to the heel, and is the largest tendon in the body. We use our Achilles tendons in during many activities, like walking, running, climbing stairs, and jumping. Achilles tendons can take on a great deal of stress, but they are also susceptible to inflammation. This inflammation is known as Achilles tendinitis.

Seaview’s foot and ankle specialists, Dr. Aron Green, Dr. Eric Beights, and Dr. George Fahoury, have over 40 years of combined experience treating running injuries, including Achilles tendinitis.

Achilles Tendinitis: Causes and Symptoms

Achilles tendinitis typically occurs due to overuse or placing too much stress on the tendon. Risk factors for Achilles tendinitis include a sudden increase in the frequency or intensity of exercise and tight calf muscles.

It is important to gradually increase your exercise activity so that your body can better adjust. It is also important to work on flexibility by stretching the calf muscles to avoid unnecessary stress to the Achilles tendon.

Bone spurs, excess bone growth where the Achilles tendon attaches to the heel, can also contribute to Achilles tendinitis by rubbing against the tendon.

Achilles tendinitis causes pain at the back of the heel along the Achilles tendon. Pain typically gets worse with activity, particularly the day after exercising. Patients may also feel pain and stiffness along the Achilles tendon in the morning. The tendon may become thickened, and swelling may occur.

If you feel a “pop” at the back of your heel, the Achilles tendon may be torn. If this happens, you should seek immediate medical attention.

Types of Achilles Tendinitis

Achilles tendinitis is divided into three different categories: paratenonitis, insertional Achilles tendinitis, and noninsertional Achilles tendinitis.

Paratenonitis is an inflammation of the paratenon, the outer lining or coating of the Achilles tendon. This condition often occurs in runners. Paratenonitis causes painful adhesions between the Achilles tendon and outer lining.

Insertional Achilles tendinitis involves the lower portion of the Achilles tendon at the point where it attaches, or inserts, at the heel. It is typically caused by overuse, but certain anatomic variances or deformities can increase the likelihood of developing insertional Achilles tendinitis. For example, patients with a square-backed heel, Haglund’s deformity, or other bony protrusions like heel spurs have a higher risk of developing Achilles tendinitis because the bone rubs against the tendon.

Insertional Achilles tendinitis can also cause inflammation of the bursa, a small fluid-filled sac at the back of the heel that reduces friction between the bone and soft tissues. Tightness in the Achilles tendon can also cause a traction injury, creating more bone spurs at the back of the heel.

Noninsertional Achilles tendinitis occurs in the middle portion of the Achilles tendon, approximately 4-6 cm above where it inserts at the heel. This area is often called the “watershed region” of the Achilles tendon because it has a poor blood supply, and does not heal as quickly as areas with greater blood supply. Noninsertional Achilles tendinitis is also a degenerative condition, in which the fibers of the tendon begin to fray and tear over time. In response to this damage, the tendon starts to thicken, causing significant pain.

Treatments for Achilles Tendinitis

Recommended treatment may vary based on the type of Achilles tendinitis. One of our board certified foot and ankle physicians, Dr. Aron Green, Dr. Eric Beights, Dr. George Fahoury, will perform an examination and create a treatment plan.

Nonsurgical Treatment

Initial treatment for Achilles tendinitis is typically conservative. Topical or oral anti-inflammatory medications may be recommended to help reduce pain and swelling.

Initial treatment for insertional Achilles tendinitis involves physical therapy, stretching, rest, ice, compression, and elevation. High energy ultrasound may also be effective for insertional Achilles tendinitis.

Physical therapy, which is offered on-site at all 5 Seaview office locations, may be helpful for patients with paratenonitis. Rest is also recommended for paratenonitis, as it often relieves symptoms. If rest and physical therapy do not relieve symptoms, your physician may recommend a procedure called braisement. During this procedure, your physician will use ultrasound guidance to inject sterile saline or Lidocaine between the Achilles tendon and the tendon sheath. This helps to break up adhesions, and is typically effective at relieving pain.

Noninsertional Achilles tendinitis may also benefit from physical therapy, particularly eccentric stretching. Eccentric stretching involves contracting, or tightening, the Achilles tendon as it lengthens. It should be done under the supervision of a qualified professional, like our physical therapy staff, as it can cause further damage to the tendon if done incorrectly.

Platelet-rich plasma (PRP) injections may also be helpful for noninsertional Achilles tendinitis. PRP involves extracting plasma from the patient’s blood to create a concentrated plasma solution that is then injected into the injured area of the patient’s Achilles tendon. Because this portion of the tendon has a limited blood supply, the PRP injection is thought to promote healing. Injection of amniotic allograft can also be helpful. Ultrasound guided needle delivery of medication (PRP, amniotic, and steroid) can be used to treat both insertional and noninsertional Achilles tendonitis.

If the Achilles tendon does rupture, which is common, it may be treated with a plantar flexion cast for approximately 8 weeks if it is detected very soon after the tear occurred and there is no gaping in the tendon. However, if the tear was not detected right away, or if there is a gap in the tendon, surgery is recommended.

Surgical Treatment

If nonsurgical treatment fails to relieve symptoms, surgery may be recommended. At Seaview Orthopaedics, our foot and ankle surgeons perform many Achilles tendon procedures each month. Surgical treatment for Achilles tendinitis may involve debridement, or removal of damaged tissue. If heel spurs are present, they may also be removed. The tendon can then be repaired.

In cases of insertional Achilles tendinitis, the tendon is detached from its insertion point at the heel, and the damaged tissue is removed. It is then reattached and repaired.

If the Achilles tendon is torn, it will most likely be surgically repaired. The goal of treating a ruptured Achilles tendon is to have the tendon heal at the correct length. Traditionally, surgical repair was done through a large open incision. However, the foot and ankle surgeons at Seaview are also trained in minimally invasive techniques for Achilles tendon repair. Minimally invasive techniques require smaller incisions and often have lower rates of complication as compared to open procedures.

For minimally invasive Achilles tendon repair, Dr. Green uses a soft tissue fixation device called the Arthrex SpeedBridge™ that improves stability and may allow for a quicker return to activities. Dr. Green is also faculty with Arthrex to teach this procedure to other surgeons.

Patients typically begin weightbearing within 6 weeks of surgery. Physical therapy, which is offered on-site for the convenience of our patients, is an important part of the recovery process. Surgery for Achilles tendinitis is very successful for the vast majority of patients, with most experiencing near complete resolution of symptoms.

Achilles Tendinitis Treatment in Jersey Shore and Central New Jersey

At Seaview Orthopaedics, we offer a full range of treatment options for Achilles tendinitis, including on-site physical therapy. Our foot and ankle specialists, Dr. Aron Green, Dr. George Fahoury, and Dr. Eric Beights are available for appointments at our five office locations. If you would like to schedule an appointment, please call (732) 660-6200. We look forward to helping you!