Achilles tendinitis overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Achilles tendinitis is tendinitis of the Achilles tendon, generally precipitated by overuse of the affected limb and is more common among athletes training under less than ideal conditions. It is a painful condition, and typically occurs due to overuse or arthritis. It should not be confused with xanthoma of the tendon, which is the accumulation of cholesterol in patients with familial hypercholesterolemia.
Pathophysiology
Achilles tendinitis is the inflammation of the Achilles tendon. The tendon does not have good blood supply or cell activity, so this injury can be slow to heal. Injury to the tendon induce blood vessel formation and nerve migration, which is what is thought to cause the pain.
Causes
The causes of Achilles tendinitis are mainly overuse (especially in athletes), arthritis in the elderly, injury, bone spurs or infection.
Risk Factors
The risk of developing Achilles tendinitis is highest in athletes who are involved in high intensity exercises. Other risk factors include a sudden increase in amount or intensity of exercise, and having tight, poorly conditioned muscles.
Natural History, Complications and Prognosis
A complication of achilles tendonitis is tendon rupture. Lifestyle changes help improve symptoms but the symptoms may return on resuming strenous activities.
Diagnosis
History and Symptoms
Achilles tendinitis presents with pain on gentle palpation of the tendon, soreness and stiffness in the morning, and swelling or warmth over the affected tendon.
Physical Examination
Key signs on physical examination are tenderness to palpation over the tendon, and trouble standing on toes.
X Ray
X-Ray is done to look for arthritis as the possible etiology for the tendinitis.
MRI
MRI is required if a tear is suspected.
Treatment
The non medical therapy for Achilles tendinitis involves treatment mainly with ice packs or a physical rehabilitation program. Medical therapy involves use of NSAIDs and if required, steroid injection. Severe cases may need orthopedic surgery.
Primary Prevention
Prevention includes appropriate exercise habits and wearing low-heeled shoes.