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Achilles Tendonitis Treatment in Orange County

Orange County Foot & Ankle Orthopedic Surgeons

The Achilles tendon is the fibrous band of tissue that connects the calf muscles to your heel bone (calcaneus), and it helps us walk, jump, pivot, run, and stand on the balls of your feet. Overuse or repetitive movements can put excess strain on the Achilles tendon, limiting the range of movement and causing painful inflammation called Achilles tendonitis. Although most cases can be treated relatively simply, more severe cases of tendon tears or ruptures may require surgical repair and ample rest before you can return to athletic activities.

There are two types of Achilles tendonitis, based upon which part of the tendon is inflamed, non-insertional Achilles tendonitis and insertional Achilles tendonitis.

  • Insertional Achilles tendonitis affects the lower portion of your tendon where the tendon attaches to your heel bone (calcaneus). In both non-insertional and insertional Achilles tendonitis, the damaged tendon fibers may calcify or harden. However, with insertional Achilles tendonitis, extra bone growth (bone spurs) often form. While tendonitis that affects the insertion of the tendon may occur in active and non-active patients, there is a higher likelihood of this condition happening after years of overuse, typically with long distance runners and sprinters.
  • Non-insertional Achilles tendonitis involves fibers in the middle portion of the tendon that have begun to degenerate (break down with tiny tears) and more commonly affects younger, more active people.

Do I Have Achilles Tendonitis?

Achilles tendonitis is most common among athletes, particularly runners who suddenly increase the length or intensity of their workout regimens. However, even older adults who suddenly begin an exercise routine that is too intense for them, or wearing old or poorly fitting shoes during physical activity, wearing high heels daily or for prolonged durations can cause Achilles tendonitis pain. If you have persistent Achilles tendon pain, an orthopedist, who is fellowship-trained in foot and ankle treatments, or a podiatrist, are the best types of doctors to involve in your treatment.

Symptoms of an Achilles tendon injury include:

  • Pain radiating down the back of the leg, near the heel that gets worse when physically active
  • Stiff, sore Achilles tendon upon awakening
  • Swelling, tendon thickening, pain that gets worse after exertion
  • Bone spurs on the heel bone
  • Limited range of motion when flexing the foot with the affected Achilles tendon
  • Tight calf muscles, typically after suddenly starting an aggressive workout program
  • Hearing a sudden “pop” sound and feeling sudden, intense pain

Diagnosing Achilles Tendonitis

Your orthopedist or podiatrist will gently press on the Achilles tendon/affected area to determine what anatomical structure is affected, as well as to assess your level of pain, tenderness, or swelling. You may be asked to stand on the balls of your feet while observing your range of motion and flexibility.

Your doctor may also recommend imaging tests which can rule out other conditions that can cause similar symptoms, including:

  • An X-ray provides images of the foot and leg bones and can show if your tendon has become calcified and if bone spurs have formed on the heel bone.
  • Magnetic resonance imaging (MRI) is useful to produce very detailed images of your affected Achilles tendon and can detect a tear or rupture and tissue degeneration.
  • Ultrasound

Treating Achilles Tendonitis

Most Achilles tendonitis patients respond well to self-care, including the classic “RICE”: Rest, Ice, Compression, and Elevation.

Nonsurgical treatment may include:

  • Immobilization or reduction of physical activity that will aggravate your Achilles tendonitis
  • Physical therapy to gently stretch and strengthen calf muscles
  • Icing the affected area after exercise or when in pain
  • Elevating your foot to decrease swelling
  • Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) for pain and swelling reduction (such as ibuprofen)
  • Wearing a brace or walking boot to prevent heel movement
  • Night splints to maintain a stretch in the Achilles tendon during sleep
  • Corticosteroid injections to relieve symptoms
  • Platelet-rich plasma (PRP) injections (results may vary)
  • Supportive shoes and orthotics to take tension off your Achilles tendon

Surgical Treatment for Achilles tendonitis

If your symptoms do not improve after 6 months of nonsurgical/conservative treatments, surgery may be considered. In some cases, surgery is the first-line treatment when the damage is severe. Surgery is used to remove the damaged tendon tissue, fix the remaining Achilles tendon, and to give the tendon extra length by surgically grafting another tendon to the heel bone for added support. Your affected leg will be immobilized after surgery in a cast so that it may heal properly. Once you have healed sufficiently, you will commence physical therapy prescribed by your orthopedic surgeon to strengthen the Achilles tendon and restore its functionality.

If you think you have Achilles tendonitis, please consult a Hoag Orthopedic Institute orthopedist, fellowship trained to treat foot and ankle conditions, or a Podiatrist for treatment.

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