Achilles tendon problems

What is Achilles tendon problems?

The Achilles tendon, located at the back of the ankle and linking the calf muscle to the heel bone, is the body’s largest tendon and facilitates activities like walking, running and jumping.

Achilles tendon pain can be experienced for a number of reasons and in more serious cases, the Achilles tendon can rupture, which may require Achilles tendon surgery.

Problems with other foot tendons can also occur.

What causes Achilles tendon problems?

Often, especially for active people in middle-age, if there is no obvious cause, tendon pain can be linked to arthritis or other inflammatory issues. Achilles ruptures are normally the result of over-training when the tendon cannot withstand the level of activity.

Tendinitis, an inflammation of the tendon causing pain and swelling, can be triggered by a variety of factors, including a change or intensification of training schedule. There are two forms of Achilles tendinitis:

• Non-insertional Achilles tendinitis occurs when fibres in the central part of the tendon break down due to miniscule tears (or degeneration), resulting in inflammation.
• Insertional Achilles tendinitis affects the lower end of the tendon, close to the heel, where it attaches to the heel bone. Sometimes, bone spurs will form on the heel bone and the sac of lubricating fluid situated behind the tendon (bursa) can get inflamed (bursitis). Insertional tendinitis can affect anyone, whether they are physically active or not.

What are the symptoms of Achilles tendon problems?

• Tendon thickening
• Stiffness and pain, particularly in the morning
• Swelling and pain at the back of the leg near the heel, which is exacerbated by exercise
• Bone spurs (in insertional Achilles tendinitis)
• Swelling worsening with activity

Seek advice as soon as possible as your symptoms may get worse.

How is Achilles tendon problems diagnosed?

Your consultant will listen and discuss the symptoms before performing a range of diagnostic tests, possibly including an X-ray or an MRI scan to determine how much damage there is to the tendon.

How is Achilles tendon problems treated?

Patients with Achilles pain do not always require tendon repair surgery. Frequently, a combination of rest and anti-inflammatory painkillers (under the direction of your GP or consultant), together with a personalised rehabilitation programme of physiotherapy will relieve the pain.

Your consultant may advise a course of steroid injections to control the inflammation. For conditions like insertional Achilles tendinitis, it can be beneficial to wear heel lifts to remove strain from the tendon. Specially designed supportive walking boots can also be useful.

Should the tendon pain not respond to treatment, your consultant may advise that an operation to remove any bone spurs (bony lumps) is necessary. If the tendon is in a very poor condition, tendon transfer surgery, involving the relocation of another tendon in the foot to support the damaged Achilles tendon, is another option.