Tendinitis of the heel
Achilles tendinitis occurs when the tendon that connects the back of your leg to your heel becomes swollen and painful near the bottom of the foot. This tendon is called the Achilles tendon. It allows you to push your foot down. You use your Achilles tendon when walking, running, and jumping.
There are two large muscles in the calf. These create the power needed to push off with the foot or go up on the toes. The large Achilles tendon connects these muscles to the heel.
Heel pain is most often due to overuse of the foot. Rarely, it is caused by an injury.
Tendinitis due to overuse is most common in younger people. It can occur in walkers, runners, or other athletes.
Achilles tendinitis may be more likely to occur if:
- There is a sudden increase in the amount or intensity of an activity.
- Your calf muscles are very tight (not stretched out).
- You run on hard surfaces, such as concrete.
- You run too often.
- You jump a lot (such as when playing basketball).
- You DO NOT wear shoes that give your feet proper support.
- Your foot suddenly turns in or out.
Tendinitis from arthritis is more common in middle-aged and older adults. A bone spur or growth may form in the back of the heel bone. This may irritate the Achilles tendon and cause pain and swelling. Flat feet will put more tension on the tendon.
Symptoms include pain in the heel and along the length of the tendon when walking or running. The area may feel painful and stiff in the morning.
The tendon may be painful to touch or move. The area may be swollen and warm. You may have trouble standing up on one toe.
Exams and Tests
The health care provider will perform a physical exam. They will look for tenderness along the tendon and pain in the area of the tendon when you stand on your toes.
X-rays can help diagnose bone problems.
An MRI of the foot scan may be done if you are considering surgery or there is a chance that you have a tear in the Achilles tendon.
The main treatments for Achilles tendinitis DO NOT involve surgery. It is important to remember that it may take at least 2 to 3 months for the pain to go away.
Try putting ice on the Achilles tendon area for 15 to 20 minutes, 2 to 3 times per day. Remove the ice if the area gets numb.
Changes in activity may help manage the symptoms:
- Decrease or stop any activity that causes pain.
- Run or walk on smoother and softer surfaces.
- Switch to biking, swimming, or other activities that put less stress on the Achilles tendon.
Your provider or physical therapist can show you stretching exercises for the Achilles tendon.
You may also need to make changes in your footwear, such as:
- Using a brace, boot or cast to keep the heel and tendon still and allow the swelling to go down
- Placing heel lifts in the shoe under the heel
- Wearing shoes that are softer in the areas over and under the heel cushion
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, can help ease pain or swelling.
If these treatments DO NOT improve symptoms, you may need surgery to remove inflamed tissue and abnormal areas of the tendon. If there is a bone spur irritating the tendon, surgery can be used to remove the spur.
Extracorporeal shock wave therapy (ESWT) may be an alternative to surgery for people who have not responded to other treatments. This treatment uses low-dose sound waves.
In most cases, lifestyle changes help improve symptoms. Keep in mind that symptoms may return if you DO NOT limit activities that cause pain, or if you DO NOT maintain the strength and flexibility of the tendon.
Achilles tendinitis may make you more likely to have an Achilles rupture. This condition most often causes a sharp pain that feels as if you have been hit in the back of the heel with a stick. Surgical repair is necessary. However, the surgery may not be as successful as usual because there is already damage to the tendon.
When to Contact a Medical Professional
Call your provider if:
- You have pain in the heel around the Achilles tendon that is worse with activity.
- You have sharp pain and are unable to walk without extreme pain or weakness.
Exercises to keep your calf muscles strong and flexible will help reduce the risk of tendinitis. Overusing a weak or tight Achilles tendon makes you more likely to develop tendinitis.
Biundo JJ. Bursitis, tendinitis, and other periarticular disorders and sports medicine. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 263.
Irwin TA. Tendon injuries of the foot and ankle. In: Miller MD, Thompson SR, eds. DeLee and Drez's Orthopaedic Sports Medicine. 4th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 117.
Yin MC, Ye J, Yao M, et al. Is extracorporeal shock wave therapy clinical efficacy for relief of chronic, recalcitrant plantar fasciitis? A systematic review and meta-analysis of randomized placebo or active-treatment controlled trials. Arch Phys Med Rehabil. 2014;95(8):1585-1593. PMID: 24662810 www.ncbi.nlm.nih.gov/pubmed/24662810.