Patient Education

Tendonitis and Tendonosis

Description

Anyone who has read up on their Greek mythology knows that an Achilles Heel isn’t necessarily a good spot to rely on. However, most of us rely on our Achilles tendon to a tremendous degree: we use it when jumping, running, walking – pretty much any time we use our foot. Despite its mythological association with weakness, the Achilles tendon (a thick, cord-like bunch of tissue that attaches the calf muscle to the back of the heel bone) is actually the strongest and largest tendon in the body. Unfortunately, it’s also susceptible to injury, since the muscles that pull on it exert more force than any other in the leg. To make matters worse, blood circulation to the tendon is relatively poor, which means that it generally isn’t able to heal quickly when injured.

Injuries tend to happen to the Achilles tendon when we overuse it, resulting in inflammation (aka tendonitis). This can happen most frequently with individuals whose activity suddenly increases or changes, such as those who are active only on weekends or who suddenly become active (yes, we’re looking at you, weekend warriors). However, tendonitis may also result from putting consistent strain on the Achilles tendon. Athletes (particularly those involved in running or jumping sports), or those whose jobs cause them to overuse their feet or ankles will likely be the ones to fall into this category.

Age may also play a factor, since tendons tend to lose flexibility as a person grows older. The tendon’s inflexibility may also be exacerbated by the wearing of high-heeled shoes, which can cause the tendon to be shortened. Fortunately, stretching properly before exercising or engaging in periods of high activity may help to reduce the chance of injuring your Achilles tendon. (And you thought stretching was useless, didn’t you?)

Over time, if the tendon is misused enough, it gets pretty messed up. Achilles tendonitis may progress to Achilles tendonosis, or full-on degeneration of the tendon, in which it becomes more likely to experience tears or, in rare cases, a rupture (which is not a pretty injury). Tearing that comes with the tendonosis is usually microscopic (except in the case of a rupture, of course) and tends to show up about 2 inches (or 6 cm) above where the tendon is inserted into the heel bone.

Symptoms

If you have the misfortune of developing Achilles tendonitis or tendonosis, you’ll likely notice swelling, tenderness, and warmth on the Achilles tendon, or sometimes on your leg above the heel, anywhere from the back of the heel to the bottom of the calf muscle. You may also be able to feel with your finger, or even notice visually that your tendon has gotten thick. Walking will probably be uncomfortable and somewhat difficult, since your tendon will be painful and weak, and if the problem is severe enough, it might completely prevent you from running around. Squeezing the sides of the tendon is likely to be quite painful, although oddly enough, pushing on the back of the tendon will be less painful.

When the tendonitis progresses to tendonosis, the symptoms will be more severe. The tendon will become even more enlarged, with funky little nodules in the damaged areas.

Diagnosis

When you go in to see your podiatrist about your painful Achilles tendon, he or she will likely feel the tendon to check for bumps, and will probably push it to see where it hurts. (This may be uncomfortable for you, but it’s
necessary to determine what the problem is.) He or she may also observe and ask questions as you walk or stand on your tiptoes, to see when the pain occurs.

Because your podiatrist is awfully clever, he or she will likely be able to diagnose Achilles tendonitis or tendonosis from a physical examination of the area. However, to make sure the diagnosis is correct, X-rays may be ordered to rule out arthritis or other causes of pain, and an MRI might be necessary to check the area if a rupture or partial rupture is suspected.

Treatment

Treating Achilles tendon problems may mainly focus on reducing the inflammation of the area, allowing the tendon time to heal without adding to the injury it has already sustained. This will probably be best accomplished by letting the area rest by immobilizing it, either by a cast or a boot. You can also try putting ice on the tendon (on for 20 minutes, off for 40 minutes), although for pity’s sake, wrap the ice in a thin towel. You should never put ice right on your skin. (Seriously – you don’t want to cause frostbite – just reduce the swelling.)

Your podiatrist may also suggest anti-inflammatory medications, such as ibuprofen, or steroid treatments such as cortisone. Physical therapy might be used to strengthen the muscles around the tendon and prevent further injury, or used to soothe the tendon and accompanying inflammation by use of ultrasound therapy or stretching, or it might simply consist of teaching you how to use your foot properly during the activities you so love to do. Like walking.

If these treatments don’t work, or if the injury to your tendon is severe enough, then surgery might be the best option to help your Achilles tendon. Your surgeon may remove the damaged part of the tendon and stitch together the remaining healthy portions. If the injury is pretty severe, the surgeon may have to grab a tendon from another part of your body in order to repair the damaged area.