Achilles tendonitis

What is Achilles tendonitis?

The Achilles tendon is the strongest and largest tendon in the body. It attaches the calf muscles to the heel bone and allows the foot to push off (eg, during walking, running, jumping).

Achilles tendonitis is a condition where this tendon becomes inflamed. The inflammation may be localised to the end of the tendon near the heel or it can spread further to affect the calf muscles higher up the leg. There is usually swelling and pain with contraction of the calf muscles. If severe, the pain may also be felt at rest.

Often Achilles tendonitis starts with a dull pain at the back of the lower leg just above the heel when pushing off the ground with the foot. Without intervention, the condition generally worsens and it becomes increasingly difficult to push the foot off from the ground.

What causes Achilles tendonitis?

In most cases Achilles tendonitis is caused by overuse. Factors that can contribute to Achilles tendonitis include:

  • Unsupportive footwear
  • Not stretching prior to activity
  • Excessive rolling in of the feet (ie, over-pronation) (increased pronation puts extra stress on the Achilles tendon)
  • A short Achilles tendon
  • Direct trauma (injury) to the tendon
  • Heel bone deformity

How is Achilles tendonitis treated?

In addition to clinical examination, you may be referred for an ultrasound in order to confirm a diagnosis of Achilles tendonitis.

The treatment of Achilles tendonitis involves three main elements:

  • Reducing inflammation (in severe/ acute cases, a splint may be recommended to immobilise the ankle)
  • Performing eccentric exercises to strengthen the calf muscles (gastrocnemius and soleus muscles)
  • Improving biomechanical control (through appropriate footwear and orthotics)

If left untreated, Achilles tendonitis can develop into a more serious condition such as Achilles tendinosis or Achilles calcific tendonitis. These conditions involve degenerative change to the tendon and are more difficult to treat. Early treatment for Achilles tendonitis is always recommended.

Haglund’s deformity

A Haglund’s deformity is a bony lump located at the back of your heel bone, where the Achilles tendon attaches to the heel. Haglund’s deformities are most often seen in people with a tight Achilles tendon, and people with a high arched foot. 

It can be painless but may also become painful and irritating from rubbing inside shoes. When this bony prominence rubs against the shoes a bursitis, which is an inflamed bursa, can develop. This bursitis can lead to redness, pain and swelling around the bony lump.

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