Achilles Tendinitis Treatment in Birmingham, AL
You don't have time to exercise during the week, but you're still active during the weekend. "Why not go hard and get a proper sweat," you think to yourself until sharp, shooting pain in your Achilles tendon gives you the answer.
The pain isn't intense enough to suggest an Achilles tendon rupture, but something is definitely off. "It will pass if I rest for a few days," you assure yourself. But as the days go by, the pain sticks around like a permanent fixture, affecting every standing activity.
A quick Google search suggests the problem might be Achilles tendinitis. Sounds serious. Let's see what it is and what we can do about it.
- What Is Achilles Tendinitis?
- What Causes Achilles Tendinitis?
- Achilles Tendinitis Symptoms
- How Do We Diagnose Achilles Tendinitis?
- Achilles Tendinitis Treatment
- When Do You Need Achilles Tendon Surgery?
- Types of Achilles Tendinitis Surgery
- How Long Does It Take to Recover from Achilles Tendinitis Surgery?
What Is Achilles Tendinitis?
The Achilles tendon connects your heel bone to your calf muscles. It's the largest tendon in the body and is involved in most movement-related biomechanical processes. This includes walking, running, climbing stairs, jumping, and standing on your toes. It's named after the ancient Greek mythological hero Achilles, whose only weakness was his heel. Achilles tendon injuries are broadly referred to as Achilles tendinopathy.
Achilles tendinitis is a specific type of tendinopathy where the Achilles tendon gets inflamed. Because the tendon is large and plays such a vital role in the movement, this inflammation can significantly affect your quality of life.
There are two types of Achilles tendinitis:
Noninsertional Achilles Tendinitis
Noninsertional Achilles tendinitis is more common in more active people. It affects the middle part of the tendon as microtears develop over time. These microtears lead to swelling, inflammation, or even calcification (or hardening).
Insertional Achilles Tendinitis
Insertional Achilles Tendinitis affects people of all activity levels. The condition involves the lower part of the tendon where it inserts into the heel bone.
Calf muscle tightness can be a contributing factor to developing this type of tendinitis. It's often accompanied by bone spurs on the heel, making it easier to diagnose.
What Causes Achilles Tendinitis?
Unlike many other foot and ankle conditions, Achilles tendinitis isn't caused by a specific injury. Those tiny tears in the tendon are the result of repetitive stress and don't happen overnight.
A sudden surge in workout intensity or physical activity can lead to tendonitis. The condition is prevalent in people who aren't active during the week but push themselves hard on the weekend.
Several factors increase the risk of developing Achilles tendinitis:
- Not giving your body enough time to adapt to stress. Athletes who try to progress too quickly risk tendon microtears. Their bodies are unable to adapt to the ever-increasing stress.
- Improper warmup. Warmups are the most mundane part of any sport, which is why people tend to do them half-heartedly. This increases the risk of injury and other issues.
- Sudden changes in direction. Playing sports like tennis and basketball where sudden changes in direction are part of the game can make your tendons vulnerable to injury
- Tight calf muscles. If your calf muscles are tight, this puts extra stress on your Achilles tendon, causing microtears and inflammation.
- Haglund's deformity. A bony enlargement on the back of the heel which rubs against the Achilles tendon is the perfect recipe for tendinitis.
Once you come in for a full examination, we'll help you determine the cause in your particular case.
The main symptoms of Achilles tendinitis are pain and swelling along the tendon (between your calf muscles and your heel). This pain tends to worsen with even mild activities, such as walking.
You may also experience a limited range of motion due to tightness in your calves. These symptoms rarely go away on their own.
Other symptoms of Achilles tendinitis include:
- Swelling in your tendon or heel
- Bone spurs in your heel
- A sore and stiff tendon in the morning
- Acute pain the day after serious strain
- Warmth around your heel or tendon
If you have one or more of these symptoms, you may have Achilles tendinitis. The only way to know for sure is if you come in for an exam. Don't hesitate to make an appointment—the sooner, the better. Otherwise, you risk the condition growing into Achilles tendinosis (a breakdown of the Achilles tendon), or even a ruptured tendon.
How Do We Diagnose Achilles Tendinitis?
The first step is physical examination. We look for the more obvious symptoms, such as bone spurs (for insertional tendinitis), swelling, and stiffness.
Next, we check your ankle mobility. Finally, we may order some imaging tests (such as X-ray, MRI, or ultrasound) to rule out other causes for your symptoms.
Achilles Tendinitis Treatment
While Achilles tendinitis does sound serious (and can make life difficult ), the good news is that there are plenty of non-surgical treatments for this condition.
Here are some recommendations for treating Achilles tendinitis:
- Rest. This is probably not what you want to hear if you're active, but this is the first step to your recovery. You need to decrease the strain on your tendons so you can give them time to heal.
- Ice. Put ice on the affected area. Keep it there until you feel some relief, but no longer than 20 minutes. Remove it immediately if you feel the skin going numb.
- Night splinting. Night splints are in a variety of conditions, including plantar fasciitis. They are removable braces that allow your foot to rest at 90 degrees relative to your leg while you sleep. This decreases the pull of the tendon on your heel and helps to maintain calf flexibility.
- Orthotics. Heel lifts help reduce the load on the Achilles tendon, which can alleviate some of your symptoms.
You might be tempted to take OTC medication, such as ibuprofen, for the pain and inflammation. While this may help with some of your symptoms, we don't recommend self-treatment. You may feel better in the short term, which may cause you to ignore the problem and rupture your tendon the next time you decide to go hard. Things get a lot more tricky if the Achilles tendon ruptures.
When Do You Need Achilles Tendon Surgery?
You've tried all the non-surgical treatments and six months later, you're still in pain. Now what?
While Achilles tendinitis is very responsive to non-invasive methods, sometimes the damage is too extensive and requires surgical intervention.
Types of Surgery
There are different types of surgery depending on the affected area and the extent of the tendon damage.
Debridement is the process of removing the damaged tissue from your tendon. If there's enough healthy tissue left, this is usually the best option.
In the case of insertional tendinitis, the bone spurs are also removed from the heel. Once the tendon is "cleaned up" from the damaged tissue, it gets reattached.
What happens if there isn't enough healthy tissue left? Debridement can be performed even if more than 50% of the Achilles tendon is damaged. However, since the remaining tissue isn't strong enough to perform the tendon functions on its own, it needs to be extended with another tendon.
Usually, this other tendon is the one that allows your big toe to point down. Your orthopaedic surgeons will remove it from the big toe and attach it to the heel bone.
You'll still be able to move your big toe after this procedure. In fact, most patients barely notice a difference. That being said, competitive sports may be out of the question.
If your tendinitis is caused by tight calf muscles, a gastrocnemius recession may be the answer. It's a simple procedure with a high success rate that surgically lengthens your calf muscles.
Surgery outcomes for Achilles tendon surgeries are very favorable. Most of our patients get back to their previous activities after a full recovery.
However, the outcomes largely depend on the extent of the tendon damage. The higher the degree of damage, the longer recovery will take. And the less likely you'll be to return to pre-surgical activity levels.
Are There Any Risks?
As with any other surgical procedure, there are some risks to consider:
- Slow recovery
- Nerve damage
- Decreased range of motion
On the bright side, these complications are rare. Most of our patients make a full recovery and get back to enjoying their lives at full speed.
How Long Does It Take to Recover from Achilles Tendinitis Surgery?
The recovery time after an Achilles tendon surgery will depend on the type of surgery and the severity of the tendon damage. In other words, the more extensive the damage, the longer it will take to heal.
Physical therapy and strengthening exercises are important aspects of recovery, whether you've had the surgery or not. Working with a physical therapist will allow you to restore strength in your tendon.
Here are a few more things you need to know:
- You'll have to wear a surgical boot for six to 12 weeks after the surgery.
- You may need the help of crutches to move around for a few weeks.
- Post-op pain is normal and to be expected. We may prescribe medication to manage the pain.
- You won't be able to drive until you can freely move your foot and you're off your pain meds (which takes approximately four to six weeks).
- You'll need to take a few weeks (or months) off work. The exact amount will depend on the severity of the tendon damage and your type of work. If you work a sedentary job, you'll be able to get back to work a lot faster than if your job is physically demanding.
Making a full recovery can take six months to a year. However, most of our patients get to enjoy their activities anew once they recover.
Not sure which treatment is the best for you? Make an appointment and we'll help you decide.