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Achilles Tendinitis

By

Paul L. Liebert

, MD, Tomah Memorial Hospital, Tomah, WI

Reviewed/Revised Nov 2023
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Topic Resources

Achilles tendon injuries include inflammation of the paratenon and partial or complete tears.

Achilles tendinitis is very common among running athletes. The calf muscles attach to the calcaneus via the Achilles tendon. During running, the calf muscles help with the lift-off phase of gait. Repetitive forces from running combined with insufficient recovery time can initially cause inflammation in the tendon paratenon (fatty areolar tissue that surrounds the tendon). A complete tear of the Achilles tendon Achilles Tendon Tears Achilles tendon tears (ruptures) most often result from ankle dorsiflexion, particularly when the tendon is taut. Diagnosis is by examination and sometimes MRI. Treatment is splinting in plantar... read more Achilles Tendon Tears is a serious injury, usually resulting from sudden, forceful stress. Tendon tears can occur with minimal exertion in people who have taken fluoroquinolone antibiotics.

Symptoms and Signs of Achilles Tendinitis

The primary symptom of Achilles tendon inflammation is pain in the back of the heel, which initially increases when exercise is begun and often lessens as exercise continues.

A complete tear of the Achilles tendon Achilles Tendon Tears Achilles tendon tears (ruptures) most often result from ankle dorsiflexion, particularly when the tendon is taut. Diagnosis is by examination and sometimes MRI. Treatment is splinting in plantar... read more Achilles Tendon Tears typically occurs with a sudden forceful change in direction when running or playing tennis and is often accompanied by a sensation of having been struck in the back of the ankle and calf with an object such as a baseball bat.

Diagnosis of Achilles Tendinitis

  • Clinical evaluation

On examination, an inflamed or partially torn Achilles tendon is tender when squeezed between the fingers. Complete tears are differentiated by

  • Sudden, severe pain and inability to walk on the extremity

  • A palpable defect along the course of the tendon

  • A positive Thompson test (while the patient lies prone on the examination table, the examiner squeezes the calf muscle; this maneuver by the examiner does not cause the normally expected plantar flexion of the foot)

Unilateral Abnormal Thompson Test
VIDEO

Treatment of Achilles Tendinitis

  • Ice, nonsteroidal anti-inflammatory drugs (NSAIDs), and stretches

  • Modification of activities

  • Sometimes a heel lift

Tendon inflammation should initially be treated with ice, gentle calf muscle stretching, and use of NSAIDs.

A heel lift can be placed in the shoes to take tension off the tendon. Athletes should be instructed to avoid uphill and downhill running until the tendon is not painful and to engage in cross-training aerobic conditioning.

Most clinicians treat complete tears of the Achilles tendon with surgical repair. However, recent studies (1, 2, 3 Treatment references Achilles tendon injuries include inflammation of the paratenon and partial or complete tears. Achilles tendinitis is very common among running athletes. The calf muscles attach to the calcaneus... read more ) have shown that nonoperative management (including highly structured rehabilitation activities) gives long-term results similar to those of surgical repair in terms of ankle strength, range of motion in the ankle, rates of repeat tear of the tendon, and ability to do pre-injury activity.

Exercises to Stretch the Achilles Tendon

Treatment references

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NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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