Back of heel pain (Achilles Tendonitis)


What is Achilles Tendonitis?

Achilles Tendonitis (or back of heel pain) is a common disorder of the heel cord whereby inflammation is present in the Achilles tendon at the rear of the ankle. This heel injury is quite common with athletes and may cause excessive heel pain. This sort of inflammation generally is a short-time problem, but if not given proper attention, it may lead to long-term damage and degeneration of the Achilles tendons. In some cases this degeneration will result in rupturing of the Achilles tendon.

Pain in the Achilles tendon occurs just behind the heel. Sufferers of back of heel pain will often also experience stiffness and inflexibility in the calf muscles. Achilles Tendonitis is often differentiated from Achilles Tendinosis, a medical condition involving chronic pain and swelling resulting from micro-tearing within the tendons.

back of heel pain Back of heel pain (Achilles Tendonitis)

General symptoms

One major symptom of Achilles Tendonitis is intense pain at the back of heel. The pain is most severe about 2-4 centimeters above the point where tendon attaches to the heels. Patients suffering from Achilles Tendonitis experience searing pain after periods of inactivity. For instance, patients experience pain when they get up after sleeping or sitting for a few hours. On the other the hand, pain may be present during or after activities like running, jumping or jogging.

Patients usually have to undergo X-rays or MRI’s to evaluate the condition, in particular to find sings of tearing in the Achilles tendon. If a surgical treatment is required, an MRI will help with pre-operative evaluation and treatment planning.

Some of symptoms associated with Achilles Tendonitis and Tendinosis include:

  • Intense pain and tenderness occurs when the tendon is squeezed from all sides. However, mild tenderness occurs when the tendon is directly pressed at the back.
  • Pain, tenderness, stiffness, inflexibility and soreness occur within the Achilles tendon. These symptoms may arise at any part of the tendon, including the area where the tendon attaches to the calf muscles
  • Pain occurring after taking rest for a while or in the morning when getting out of the bed. Although the pain subsides in course of the day, it will worsen due to increased activity.
  • As this medical disorder begins degenerating, the tendon gets enlarged, resulting in the development of nodules in the areas where the tissue has been damaged.

What causes Achilles Tendonitis?

Frequent straining due to overuse causes inflammation of the Achilles tendon. In rare cases, the strenuous activity may force the tendon to rupture. Increase in strenuous activity often leads to micro-injury to the fibres of the tendon. With ongoing strain on the tendon, the body can’t repair the injured tissue.

Most athletes will develop Achilles Tendonitis as athletes commonly put excessive stress on their feet and ankles as a rsult of chronic overuse.  This overuse injury causes degeneration of the tendon and worsens the condition. Stiff calf muscle may also lead to Achilles Tendonitis. With growing age, our tendons degenerate and begin to suffer from wear and tear thus resulting in the weakening of the fibers within the tendon. Like any other tissue in the human body, the tendons tend to become rigid with enhanced susceptibility to injuries. So, middle-aged athletes are more prone to Achilles Tendonitis than young adults.

Two major causes of Achilles Tendonitis are inflexibility and over-pronation. People with extreme pronation tend to develop this medical disorder at a faster pace. This is mainly due to the fact that these people place greater stress on the tendons when they walk. Most people roll their feel inwards and force the lower leg to swivel internally, thus creating pressure on the calf muscles. As these calf muscles are attached to Achilles tendon, it is natural that achilles tendon gets overstretched and leads to inflammation. If people wear faulty shoes, it is natural that over-pronation will occur and result in the aggravation of the Achilles tendon.

Another cause of Achilles Tendonitis is changes in exercising schedule and footwear. The symptom of this medical disorder is widely found in runners who try to constantly enhance their mileage and indulge in strenuous hill training sessions.

Treatment procedures for Achilles Tendonitis

During the course of treatment for Achilles Tendonitis, the attending physicians tend to examine the ankle and foot of the patient to evaluate the extent of severity. X-rays and imaging modalities are advised to further assess the state of the tendons.

Two things are taken into consideration before the physician decides on a treatment for Achilles Tendonitis- for how long have the injury been there and the extent of damage caused to the tendons. If the disorder is at its early stage, cures like immobilization, ice treatment, orthotics, night splints and oral medication are advised. Some doctors recommend physical therapy that includes stretching, tissue mobilization, strengthening exercises and ultrasound treatment.

However, if the non-surgical treating procedure fails to improve the condition of the tendon, surgery may be needed. Before the surgeon suggests invasive treatment, they will collect information on the patient’s age, their activity level, extent and severity of the injury.

To prevent the recurrence of Back of Heel Pain after surgery, the doctors recommend strengthening of the calf muscles through daily exercises. Wearing the right kind of footwear and indulging in activities are also advised, because these are critical to the prevention of repeat disorder at the heel.

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