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What is Achilles tendinitis?
Achilles tendinitis is an inflammation of the Achilles tendon, the largest tendon in the body. This often occurs due to injury or overuse. The Achilles tendon connects the calf muscles to the heel bone and is vital in numerous activities such as running, walking, jumping, and climbing stairs.
The Achilles tendon essentially helps raise us up on our tiptoes, which is necessary for the various activities mentioned above. This repetitive motion, together with inadequate rest time between activities, can cause the Achilles tendon to become irritated and inflamed, resulting in the painful condition of Achilles tendinitis.
There are two main types of Achilles tendinitis:
- Insertional Achilles tendinitis: insertional Achilles tendinitis involves the lower part of the Achilles tendon, where it connects to the heel bone.
- Non-insertional Achilles tendinitis: non-insertional Achilles tendinitis involves the middle part of the Achilles tendon.
What causes Achilles tendinitis?
The main cause of Achilles tendinitis is repetitive stress or overuse of the Achilles tendon, which can be caused by the following:
- Intense physical activity involving running, jumping, or directional change
- Tight or weak calf muscles, which can put additional strain on the Achilles tendon
- Inadequate warm-up before exercise
- Sudden increase in intensity or duration of physical activity
- Improper footwear with inadequate support for the feet
- Structural abnormalities in the foot or lower leg, such as flat feet, Haglund’s deformity, or high arches
What are the symptoms of Achilles tendinitis?
The symptoms of an inflamed Achilles tendon are typically felt on the lower calf just above the heel bone. Symptoms of Achilles tendinitis include:
- Heel or ankle pain
- Ankle stiffness
- Tenderness and swelling along the Achilles tendon
- Difficulty walking, running, and other activities that require input from the Achilles tendon
- Gradual worsening of pain during activity
- Pain that improves with rest
- Formation of bone spurs
Who is at risk of Achilles tendinitis in Singapore?
Achilles tendinitis is a type of sports injury frequently seen among athletes. However, there are additional risk factors for developing Achilles tendinitis; these are:
- Athletes: professional athletes and weekend warriors (individuals who play sports on the weekends) who participate in sports that involve repetitive jumping, running, or sudden changes in direction are at a higher risk. Individuals who only participate in sports on the weekends are prone to Achilles tendinitis because their bodies are not used to the amount of sudden and intense stress.
- Age: Achilles tendinitis is more common in middle-aged individuals, particularly those between 30 to 50 years old. As people age, the tendons become less flexible and more prone to injury.
- Gender: men are more likely to develop Achilles tendinitis than women, possibly due to differences in muscle mass and biomechanics.
- Tight or weak calf muscles: poor flexibility or strength imbalance in the calf muscles can increase stress on the Achilles tendon, making it more prone to irritation and inflammation.
- Flat feet or high arches: individuals with flat feet or high arches can alter the biomechanics of walking or running, leading to an increased strain on the Achilles tendon.
- Overpronation or supination: overpronation occurs when the arch collapses during walking or running, while supination occurs when weight is shifted onto the outside of the foot while walking or running. Both these issues can contribute to pressure and strain on the Achilles tendon.
- Training errors: sudden change or increase in training intensity, duration, or frequency without adequate rest and recovery can overload the Achilles tendon, leading to injury.
- Improper footwear: wearing shoes that do not provide proper support, cushioning, or stability can increase the risk of Achilles tendinitis. Proper footwear is important in treating and preventing Achilles tendinitis.
- Obesity: excess body weight can place additional stress on the Achilles tendon, increasing the risk of injury.
- Medical conditions: certain medical conditions, such as psoriasis, rheumatoid arthritis, gout, or high blood pressure, increase the risk of developing Achilles tendinitis.
- Medications: certain medications, such as fluoroquinolone antibiotics, increase the risk of Achilles tendinitis.
By understanding these risk factors, individuals can reduce their likelihood of developing Achilles tendinitis by maintaining proper conditioning, wearing appropriate footwear, and incorporating rest and recovery into their training regimen.
How is Achilles tendinitis diagnosed?
Diagnosis of Achilles tendinitis involves a combination of the following:
- Physical examination: a physical exam will be conducted to examine the Achilles tendon. Your pain specialist will look for areas of swelling and tenderness and check your foot and ankle for flexibility, range of motion, alignment, and reflexes.
- X-ray: although X-rays cannot visualise tendons and other soft tissues, they can help rule out other conditions that cause symptoms similar to Achilles tendinitis.
- Magnetic resonance imaging (MRI): an MRI can visualise the Achilles tendon and identify signs of irritation and inflammation.
- Ultrasound: ultrasounds can visualise soft tissues such as tendons, and a colour-Doppler ultrasound can also analyse blood flow to the Achilles tendon, allowing for an accurate diagnosis of Achilles tendinitis.
What are the treatment options for Achilles tendinitis in Singapore?
There are various treatment options for Achilles tendinitis, including surgical and non-surgical. Non-surgical options for Achilles tendinitis include:
- RICE method: the RICE method – rest, ice, compression, and elevation will be recommended as a first line of treatment for Achilles tendinitis.
- Medication: non-steroidal anti-inflammatory drugs (NSAIDs) may be prescribed to alleviate pain and reduce swelling.
- Physical therapy: physical therapy introduces exercises that help strengthen weak calf muscles and improve flexibility, thus reducing pressure and strain on the Achilles tendon.
- Extracorporeal shockwave therapy (ESWT): ESWT uses high- or low-energy shockwaves to stimulate healing in the inflamed Achilles tendon.
Frequently asked questions
Don’t ignore pain in your Achilles tendon. Get sufficient rest in between your exercise sessions. If you notice pain in your Achilles tendon, practice the RICE method.
If you suffer from Achilles tendinitis, avoid incline walking or running, sprinting, and jump training or pylometrics.
Yes, inflammatory arthritis such as psoriatic arthritis and ankylosing spondylitis has been linked to Achilles tendinitis.
With adequate rest and avoidance of physical activity, acute Achilles tendinitis typically heals in three to four weeks. However, chronic Achilles tendinitis may take three weeks to 18 months.
Total Pain Specialist