With age, the collagen fibers may become less flexible and weak. Injuries tend to occur in middle-aged athletes.
Small ‘micro-tears” in the tendon may occur as part of an over-use injury. This may result in inflammation and painful swelling as the body attempts to repair the tendon. Some people have a prominent bump of bone at the top of the heel which can cause inflammation of the tendon and the pocket of fluid (called a bursa).
What are the most common causes of Achilles tendon pain?
The Achilles tendon is the largest and strongest tendon in the human body. When we flex our calf muscles, the Achilles tendon pulls on the heel. This movement allows us to stand on our toes when walking, running, or jumping.
But just because it’s strong doesn’t mean it can’t be injured, leading to pain. These are the common issues causing pain associated with this important tendon:
- Achilles tendon tear — Tears of the Achilles can be tiny microtears or large tears. In a tear, some of the fibers remain intact.
- Achilles tendon rupture — A complete rupture of the Achilles means the fibers are completely disconnected.
- Achilles tendinitis — Frequent activity, such as running, can gradually inflame the Achilles tendon, causing pain and stiffness at the back of the heel.
- Achilles peritendinitis — This is similar to Achilles tendonitis, but inflammation and pain occur in the tissue surrounding the tendon.
- Achilles tendinosis — This is a general thickening of the Achilles tendon without apparent inflammation, due to aging or continuing overuse. This thickening weakens the tendon.
- Achilles or heel bursitis — Shoes that ride low on the heel can irritate the bursa, the sac of fluid that cushions the Achilles.
What are the symptoms of Achilles tendonitis?
The pain associated with Achilles tendinitis typically begins as a mild ache in the back of the leg or above the heel after running or other sports activity. The pain may become more severe after prolonged running, stair climbing, or sprinting. You may experience stiffness and tenderness in the morning when you first get out of bed. This will go away with the mild activity of moving about the house.
When should I see a doctor for my Achilles tendon pain?
It is possible to partially tear your Achilles and not need to see a doctor. If you don’t keep using the tendon in the same ways you injured it, it may be able to heal. This is only the case if your symptoms are mild. Rest may allow it to heal.
However, if the pain is more severe, this wouldn’t be a minimal tear. It is likely the pain is now impacting daily activities, such as walking. Now it is definitely time to see a doctor.
If you hear a popping or snapping sound while moving, you’ve likely torn your Achilles and now it’s imperative to see a doctor immediately.
What’s involved in diagnosing Achilles tendon pain?
When you come to see Dr. McCarty at Sports, Occupational, and Knee Surgery, she’ll first have you describe your symptoms and your concerns. She will then examine your foot and ankle. These are the signs she will look for:
- Swelling along the Achilles tendon or at the back of your heel
- Thickening or enlargement of the Achilles tendon
- Bony spurs at the lower part of the tendon at the back of your heel (insertional tendinitis)
- The point of maximum tenderness
- Pain in the middle of the tendon (non insertional tendinitis)
- Pain at the back of your heel at the lower part of the tendon (insertional tendinitis)
- Limited range of motion in your ankle, specifically decreased ability to flex your foot
She may order tests to confirm her diagnosis of Achilles tendinitis. These may be x-rays or magnetic resonance imaging.
Achilles Tendinosis Treatment Options
The majority of patients with Achilles tendinosis do not require surgery. As with any other type of over-use injury, rest from the precipitating cause along with specific stretching exercises usually help. A 1cm heel lift may be placed in the shoes for a short time to help reduce the final strain on the tendon during walking. Physical therapy, immobilization, and injections (PRP, cortisone) may be helpful. Sometimes, an MRI will be ordered.
If surgery is required, then this is aimed at removing the inflamed tissue from the tendon or its lining. In Insertional Achilles Tendinosis the bony bump on the heel and the inflamed bursa may also be removed.
The treatment of Achilles Tendon Pain in San Antonio, TX with Dr. Kathren McCarty at Sports, Occupational, and Knee Surgery may be immobilization in a plaster cast or boot for several weeks. However, surgery to repair the tendon may be advised as this can lead to a more rapid recovery and return to sporting activities. Surgical repair also has a lower rate of re-rupture and is stronger.
How long does Achilles tendonitis take to heal?
Achilles tendinitis doesn’t resolve quickly. It will take months for your symptoms to completely resolve. If you’ve addressed your pain early on, it will probably take at least three months for the pain to go away. However, if you’ve opted to keep pushing through the pain, your tendinitis is likely more ingrained. Now it will take six months for your treatment to start taking effect.
Achilles tendon rupture
With a sudden rupture of the whole tendon, it is usually obvious that a severe injury has occurred. Some people report hearing a “crack” with a sharp pain behind the heel as if someone has hit them. There is normally an immediate weakness of ‘push-off” when walking.
What’s the difference between a torn and a ruptured Achilles tendon?
The difference in these terms is simply the degree. The Achilles is made up of fibrous tissue. When some of those fibers tear, but others are still whole, that is a tear in the Achilles tendon. If all of the fibers tear and there is no longer any connection, that is an Achilles tendon rupture.
Achilles Tendon Repair Recovery
With prompt attention, people can usually return to their previous activities after rehabilitation. Most patients can expect to return to jogging at 3 months and running/jumping sports by 6 months. With delayed treatment, re-rupture or chronic issues are more likely. If treatment is delayed the tendon can lengthen leading to reduced power. A long delay of several weeks poses a difficult surgical problem as tendon grafts may be required in order to reconstruct the action of the Achilles tendon.
How long does it take for an Achilles tendon rupture to heal?
After a ruptured Achilles tendon is surgically repaired, it will take from four to six months for you to get back to full activity. But your tendon will not be fully recovered until about one full year. It will not be as strong as it was before the injury, so you will want to consider changing sports. For instance, if you ruptured your tendon playing indoor volleyball, you may want to not tempt future injury by continuing with this jumping-intensive sport.
Should I use ice or heat for Achilles tendon ruptures?
If you hear a popping or snapping sound when making a movement, that could point to an Achilles rupture. That would mean an immediate visit to your doctor or to Dr. McCarty at Sports, Occupational, and Knee Surgery.
When you’re first injured and can’t yet get to a doctor, you should use ice on your damaged Achilles. Ice numbs the pain and causes the blood vessels to constrict. That’s why ice reduces swelling. In a case of a rupture or severe tear, however, icing is not to be seen as a substitute for seeing a doctor.
Should I use ice or heat to treat Achilles tendonitis?
When Achilles tendinitis starts to cause pain, it’s a good idea to use only ice for the first three days. As mentioned above, this numbs the pain and causes the blood vessels to constrict, which helps reduce swelling.
Ice the area for just 15 to 20 minutes every four to six hours. Be sure to have a towel or cloth between the ice pack and your skin. Do this for three days.
Once you move past three days, heat may help more for chronic Achilles tendinitis. Now heat can be beneficial because it increases blood flow to the area and that helps to heal the microtears that are causing the pain.
Is it safe to exercise with Achilles tendonitis?
Since you have tendinitis and not a tear in your Achilles, you can continue various types of exercise. But the sport or activities that have led to your inflammation and ongoing pain need to be curtailed in order to let the tendinitis calm down and the pain to resolve. If you feel it was running that caused your Achilles tendinitis, you’ll need to stop running until it resolves if you want to reduce the stress on the tendon and allow it to heal. You could switch to biking or swimming over this time so that you can keep exercising.
Why Choose Sports, Occupational, and Knee Surgery, P.A.
Dr. Kathren McCarty combines knowledgeable and honest care with the most advanced technology in the Greater San Antonio region to treat patients with Achilles Tendon Pain in San Antonio, TX. Healthy, happy feet are only a click or call away.
Schedule Your Consultation Today
A healthy and happy body is only a click or calls away. Call Sports, Occupational, and Knee Surgery today for an achilles tendon pain relief appointment at (210) 696-9000 at either our San Antonio or Schertz location.