Definition

Tendinopathy is an injury to the tendon. It can cause pain, swelling, and limit movement. The injuries can include:

  • Tendinitis—an inflammation of the tendon. (Although this term is used often, most cases of tendinopathy are not associated with significant inflammation.)
  • Tendinosis—microtears (tiny breaks) in the tendon tissue with no significant inflammation.

The achilles tendon connects the calf muscles to the heel bone. Tendinopathy and the associated pain may take months to resolve.

Achilles Tendonitis

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Causes

Tendinopathy is generally caused by overuse of a muscle-tendon unit. Over time, the strain on the tendon causes structural changes within the tendon itself.

Overuse of the achilles tendon is common when:

  • Increasing your speed or running long distances too quickly
  • Suddenly adding strenuous hills or stair climbing to your exercise routine
  • Doing too much too soon after taking time away from exercising
  • A sudden or violent contraction of the calf muscles, such as during an all-out sprint
  • Running too much (overuse)
  • Lack of flexibility of the calf muscles

Risk Factors

Factors that increase your chance of achilles tendinopathy include:

  • Improper or badly worn footwear
  • Improper warm-up for your activity
  • Inflexibility of the calf muscles
  • Improper cool-down
  • An improper training program

Symptoms

Symptoms may include:

  • Tenderness—usually located one to two inches above the point where the tendon attaches to the heel bone (noticeable in the morning upon rising)
  • Stiffness that gradually eases as the tendon is warmed-up
  • Pain after activity that gradually worsens
  • Radiating or localized pain along the tendon during and/or after running
  • Swelling in the area of the achilles

Diagnosis

The doctor will ask about your symptoms and exercise habits. A physical exam will be done.

Your doctor will likely make a diagnosis based on the exam and history. If the symptoms and signs are unclear your doctor may order:

  • X-rays—to see if there is calcium in the tendon
  • MRI scan—to view areas of interior damage to the tendon

Treatment

Rest

Take a break from the activity that caused the tendinopathy. Switch to an activity that doesn't put stress on the tendon. Avoid uphill and irregular surfaces. Swimming is a good option.

Gradually increase your activity levels. Ice the area for 20 minutes if you have activity related pain.

Orthoses

You may be advised to wear a shoe insert. It will place your foot in the correct position for walking and running.

Physical Therapy

  • Stretching
  • Massage
  • Ultrasound
  • Strengthening exercises, focused on the calf muscles

Medications

Some people may benefit from nonsteroidal anti-inflammatory agents (NSAIDs). They may be helpful in relieving the pain and decreasing inflammation. This is not curative. It must be combined with other treatment.

Prevention

To decrease your chances of getting achilles tendonitis:

  • Take the time to warm-up and cool-down properly.
  • Wear appropriate footwear for your sport.
  • Do not use shoes beyond the recommended duration. This will depend on:
    • How frequently you exercise
    • The surface on which you exercise
    • The conditions in which you exercise
  • Gradually add hill work, stairs, speed, and distance to your routine.
  • Stretch and strengthen the calf muscles regularly.