Achilles Tendinitis Treatment in Delhi, India

Achilles tendinitis is a condition in which the Achilles tendon, a fibrous and strong tissue that connects the calf muscles to the heel bone, becomes inflamed. This tendon is needed for walking, running, and jumping, however, when it becomes weak or strained, pain and swelling can develop around the back of the heel. Achilles tendinitis is more common in athletes and individuals who engage in activities such as running, jumping, or performing taxing exercises without adequate rest. It can also affect those who suddenly increase their physical activity levels or wear poorly fitted shoes. Symptoms include pain, stiffness, and swelling in the lower legs.

Achilles tendinitis is classified into two types.

Insertional Achilles Tendinitis

Insertional Achilles tendinitis involves the lower end of the Achilles tendon, where it attaches the heel bone. This type is more common in people who engage in rigorous exercises like running or jumping, but it can also affect those who exercise less frequently. 

Non-insertional Achilles Tendinitis

Non-insertional Achilles tendinitis affects the middle section of the tendon, located 2-6 cm above the heel. It is most commonly seen in the young working population. This type results in tendon thickening and small tears within the tendon fibres, causing swelling, stiffness, and pain along the tendon.

Achilles tendinitis typically results from stress on the Achilles tendon, causing inflammation and tiny tears in the tissue. Here are some common causes:

• Increase Physical Activity Levels: A sudden increase in the intensity or duration of exercises such as running or jumping puts excessive pressure on the Achilles tendon.
• Overuse: Repeated movements or insufficient rest can lead to small tears in the tendon.
• Tight Calf Muscles: Tight calf muscles create tension that directly impacts the Achilles tendon, particularly during exercises requiring flexibility and mobility.
• Improper Footwear: Improper footwear, such as those with thin soles, can increase stress on the Achilles tendon, potentially causing heel pain.
• Flat Feet or High Arches: Certain foot shapes, such as flat feet or high arches, can place uneven pressure on the foot and Achilles tendon, increasing stress.

Certain factors can put a person at a higher risk for Achilles tendinitis. These include:

• Age: Achilles tendinitis is more common in middle-aged and older individuals as tendons lose flexibility with age. 
• Gender: Achilles tendinitis is more prevalent in men, possibly due to hormonal factors, although this is not fully understood yet.
• Physical Activity Level: The risk of tendon strain and overuse also rises with high impact activities such as running, basketball, and tennis.

Common symptoms associated with Achilles tendinitis include:

• Heel and ankle pain
• Stiffness in the tendon
• Swelling around the tendon
• Limited range of motion
• Difficulty standing on toes

Generally, a physical exam is sufficient to diagnose achilles tendinitis. After a physical exam, the doctor may recommend imaging tests to better understand the severity of the condition.

Physical Exam

The doctor typically begins by discussing the symptoms and checking for pain and swelling in the tendon area. The affected area is gently pressed to determine the exact location of swelling and tenderness. Flexibility and range of motion of the foot and ankle are also evaluated during a physical exam.

Imaging Tests

The following imaging tests may be ordered to further evaluate the condition:

• X-rays: While X-rays cannot capture soft tissues like tendons, they help rule out other conditions with similar symptoms.
• Ultrasound: Ultrasound provides detailed images of the tendon and can produce real time images of the Achilles tendon in motion. A colour-doppler ultrasound may also be used to evaluate blood flow around the tendon.
• MRI: MRI produces high contrast, detailed images of the tendon and can help identify ruptures or tissue degeneration.

Various treatment options are available for Achilles tendinitis. These include:

RICE Method

The RICE (Rest, Ice, Compression, and Elevation) method can be highly effective in treating Achilles tendon. 

• Rest: Resting the tendon by avoiding pressure or weight on it for at least 1-2 days, or until walking pain-free, can significantly aid healing. No additional strain on the tendon helps it heal faster.
• Ice: Inflammation and swelling can be greatly reduced by icing. Apply an ice pack to the tendon for about 15–20 minutes at a time. 
• Compression: Wrap a compression bandage or a piece of cloth around the injured area. This helps compress the swelling. Make sure it is not too tight as it might constrict the blood flow.
• Elevation: Lie down and elevate the foot heart level by putting the foot on a pillow or any elevated surface to minimise swelling.

Physical Therapy

Stretching and strengthening exercises help promote healing of the achilles tendon and its supporting structures. Consult a physical therapist to know about exercises that are safe for an injured tendon.

Medications

Anti-inflammatory and pain-relieving medications are prescribed to help alleviate the symptoms until the tendon heals.

Surgery

If the above-mentioned methods do not work, then surgery may be required to repair the achilles tendon. Surgery can be performed in several ways:

• Gastrocnemius recession: A procedure to lengthen the calf muscles.
• Debridement: The removal of damaged tendon tissue and stitching together of the remaining healthy tendon.
• Tendon transfer: Strengthening the area by using a tendon from the big toe.

The severity of the condition determines the most suitable type of surgery.

Untreated Achilles tendinitis can lead to complications such as:

• Tendon degeneration: Also referred to as tendinosis, this occurs due to repetitive stress on the tendon without adequate rest. The collagen fibres within the tendon weaken, increasing the risk of further injury.
• Achilles Tendon Rupture: In severe cases, the tendon may partially or completely tear, causing intense pain and often requiring surgical intervention for healing.
• Reduced Mobility: Pain and stiffness in the ankle can restrict movement, making activities such as walking, climbing stairs, or participating in sports difficult.

Preventing Achilles tendinitis involves:

• Warm-Up and Cool Down:  Aerobic exercises with proper stretches before and after workouts can minimise the risk of injury.
• Gradually Increase Activity: Avoid sudden increases in exercise intensity to prevent excessive stress on the tendons.
• Wear Proper Footwear: Use supportive, shock-absorbing shoes to protect the Achilles tendon from strain and damage.
• Strengthen Calf Muscles: Perform regular calf-strengthening exercises to enhance tendon resilience and reduce pressure on the Achilles tendon.
• Take breaks: Prevent overstraining the tendon by incorporating regular rest periods into your exercise routine.

How much time does it take for Achilles tendinitis to heal?

The healing time depends on the severity and type of Achilles tendinitis. Most cases improve within 4-6 weeks, but severe cases or complications may take longer.

Can athletes prevent Achilles tendinitis?

Yes, athletes can minimise the risk by warming up and cooling down adequately, increasing exercise intensity gradually, and wearing suitable footwear to support the Achilles tendon.

When does Achilles tendinitis require surgery?

Surgery is usually advised for severe tendon ruptures or when symptoms persist for months despite non-surgical treatments such as rest, physical therapy, and medications.

Does Achilles tendinitis occur only due to physical activity?

While overuse from physical activity is a common cause, other factors such as tight calf muscles, poorly fitting footwear, flat feet, or high arches can also lead to Achilles tendinitis.

Is it safe to exercise with Achilles tendinitis?

High-impact activities, such as running or jumping, should be avoided until the tendon fully heals. Low-impact exercises, like swimming or cycling, are usually safe during recovery.

Reviewed By Dr Nitiraj Singh Oberoi, Director, Orthopaedics & Joint Replacement, Spine Surgery on 07 Jan 2025.