Achilles Tendinitis

Signs and Symptoms

The Achilles tendon, which pulls up the back of the heel, is the largest tendon in the body and can withstand forces of 1,000 pounds or more. It also is the most frequently ruptured tendon. Both professional and weekend athletes suffer from Achilles tendinitis, a common overuse injury and inflammation of the tendon.

Signs and symptoms of tendinitis include:

• Mild pain after exercise or running that gradually worsens
• A noticeable sense of sluggishness in your leg
• Episodes of diffuse or localized pain, sometimes severe, along the tendon during or a few hours after running
• Morning tenderness about an inch and a half above the point where the Achilles tendon is attached to the heel bone
• Stiffness that generally diminishes as the tendon warms up with use
• Some swelling

Diagnosis

Tendinitis is most often diagnosed by evaluating factors that indicate muscular overuse. Tendinitis often will develop when you suddenly increase your level of activity without adequate training or conditioning. This occurs frequently in occupational and recreational settings.

In addition to evaluating factors that are likely to lead to tendinitis, your doctor may use several physical examination procedures. Most tendons are near the surface of the skin and can be easily touched or pressed in order to make a diagnosis. Pressure placed directly on these tendons is likely to cause discomfort. In addition, your doctor may ask you to contract the muscle attached to the tendon, usually against resistance, to see if this causes pain.

Treatment

Conservative treatment can include resting and taking anti-inflammatory medications, using heel pads or shoe inserts designed to relieve stress on the tendon and exercises to strengthen the weak muscle group. Surgery is an option of last resort. However, if friction between the tendon and its covering sheath makes the sheath thick and fibrous, surgery to remove the fibrous tissue and repair any tears may be the best treatment option.