Achilles tendinosis (tendinitis achillis) is an inflammation of the achilles tendon, the tendon that runs from the calf muscle to the heel. It is a so-called sterile inflammation (non-bacterial). The inflammation is painful and can make activity impossible.
This injury is, just like heel spur, a common and often chronic injury. It is common in runners, and it is the cause of 6-17% of all sports injuries! The scientific name for Achilles tendinosis is tendinitis achillis. Instead of tendinosis there can also be tendinitis (degeneration tendonitis): the tendon is not inflamed, but is damaged. In serious cases, the Achilles tendon is not only inflamed, but can even cause an Achilles tendon rupture, or a (partial) tear of the tendon. In addition, there may be bursitis of the Achilles tendon, an inflammation of the bursa of the tendon.
The part of the achilles tendon that is inflamed is usually the part just above the heel, where the attachment of the tendon starts. It is here that the blood flow of the tendon tissue is the worst, so that recovery from a small inflammation is difficult, and a serious inflammation can occur.
Causes of Achilles Tendinosis
The cause of achilles tendon inflammation is often identical to that of heel spurs: Overloading by one-sided or too fanatic sports and wrong footwear (little cushioning, no proper footbed) are in many cases responsible for the complaint, often in combination with deviations such as flat feet, sagging feet or weak ankles. All these factors contribute to an unnatural load on the Achilles tendon, causing it to become damaged and possibly inflamed.
Other causes are:
- Overpronation, a deviation in the position of the foot with the foot swallowing a little inside.
- Age (wear)
- Leg length difference
- Excessive weight
- Instability of the ankles
- A sudden change in exercise can also be a cause, such as mountain hiking during a holiday, or a sudden increase in the number of training kilometers in runners, for example when training for a marathon.
- Hard surface when exercising
- Untrained fanatic sports
- Footwear in which the Achilles tendon is trapped.
- Antibiotic use: In rare cases, the tendon may become inflamed with the use of some antibiotics (including fluoroquinolones, orloxacin). If you notice that you get bothered, go straight to your doctor.
Usually the cause of the injury is not a "real" inflammation of the tendon, but degeneration of the tissue in the tendon (mini-cracks).
Typical symptoms of Achilles tendonitis are the following:
- Initially, only slight pain occurs immediately after exercise and disappears after a few hours. The pain in the Achilles tendon usually concentrates a few centimeters above the heel. If these complaints are ignored, the pain on the achilles tendon can worsen, and persist. In case of a warm-up, the pain symptoms can sometimes disappear temporarily, to come back after the training. In severe cases, the pain is continuously present, and does not disappear anymore at rest.
- Especially after rest or in the morning, the area around the tendon and the tendon itself can feel stiff. Finally, the tendon can be somewhat swollen.
- In the case of achilles tendon rupture (rupture) a severe pain in the Achilles tendon occurs and walking is immediately impossible. The spot of the rupture can also be observed with the eye.
The diagnosis can be confirmed with X-ray photographs or sometimes even an MRI scan. Lime formation can often be seen.
Treatment & therapy
In the early stages the injury can often be treated well, only when the injury becomes chronic is this more difficult. So, what can we do:
- Warming up: Make sure you load the load quietly. Start quietly and do light stretch exercises. Even after the training it is important to calm down again by means of cooling down exercises such as quiet walking out.
- Perform stretching and stretching exercises, especially for the calf muscles (the long and the short). A number of exercises that are called stretching exercises on the heel track page are also very suitable for the treatment of Achilles tendonitis.
- Muscle strengthening exercises for the calf muscle. Stand with the toes on the stairs with the heel down and slowly raise the body. Possibly this can be done with 1 leg at the same time, but beware of overload. Do this preferably under the supervision of a physiotherapist.
- The Strassburg Sock often helps, due to the stretch that is exerted on the calf muscles at night.
- Cooling with ice (not directly on the skin) can help in the acute stage by stimulating blood flow to the area. Do this especially after training, and preferably several times a day. This method is less effective in chronic inflammation.
- Massage of the calf muscle helps both the prevention of Achilles tendonitis and its treatment. Have this done by an experienced masseur.
- Good shoes are very important, do not economize on this. Any good running store can advise you on this, or go to a specialized (orthopedic) store. Pay particular attention to a good footbed and good cushioning.
- Insoles can, in addition to good footwear, sometimes help for the inflammation. A podotherapist can tailor-make soles that support the foot even more, especially with foot defects such as flat feet and hollow feet.
- Heel cushions under the heel, for cushioning and softening. Sometimes leg length differences can also be eliminated.
- Bandages, such as the Achillotrain, which have a massaging effect on the achilles tendon.
- Kinesiotape can sometimes also help, such as KT Tape in our webshop.
- Sometimes anti-inflammatory drugs such as ibuprofen and the like can have an effect.
- Injections with corticosteroids are sometimes still used, but the effectiveness of this is doubted, and there is also a chance of side effects.
- Surgery can be an ultimate solution: the affected tendon part is released, cleaned and then re-attached. After the operation, a few weeks of rest must be held, and must be walked with crutches.
- Gastroc slide operation: If the cause lies in a short calf muscle, it is sometimes decided to extend it using the so-called gastroc slide operation.
Treatment of achilles tendon inflammation often has to be sustained for a long time, since the complaint can be very persistent. Be especially careful with taxing too soon, otherwise the complaint can come back soon.
Achilles tendon bandages
With an Achilles tendon bandage you can often do something about your inflammation. This bandage is one of the few self-help tools developed specifically for Achilles tendon injuries. Fortunately, they are often effective. A good example is the Achillotrain of Bauerfeind:
They are often prescribed by hospitals after ruptures or operations, but you can also apply them yourself. The effect is twofold:
- 1: A silicone piece is woven against the Achilles heel. This provides a constant massaging effect on the tendon. It sounds very simple, but surprisingly often effective.
- 2: In addition, there is a small silicone heel under the heel. This provides a slight heel increase, which relieves the tendons in the heel.