Alternate Names: Tendonitis of the heel

Causes and Risks:

There are two large muscles in the calf, the gastrocnemius and soleus, that generate the power for pushing off with the foot or going up on the toes. The large Achilles tendon connects these muscles to the heel.

These are important muscles for walking. This tendon can become inflamed, most commonly with overuse or arthritis, although inflammation can also be associated with trauma and infection.

Tendonitis secondary to overuse is most common in younger individuals and can occur in walkers, runners or other athletes, especially in sports involving jumping like basketball. Jumping places a large amount of stress on the Achilles tendon.

Tendonitis from arthritis is more common in the middle aged and elderly population. Arthritis often causes extra bony growths around joints, and if this occurs around the heel where the Achilles tendon inserts on the heel bone, then the tendon can become inflamed and painful.

Prevention:

Prevention is very important in this disease. Maintaining strength and flexibility in the muscles of the calf will help reduce the risk of tendonitis. Overusing a weak or tight Achilles tendon is a set-up for tendonitis.

Symptoms:

Symptoms usually include pain in the affected heel when walking or running. The tendon is usually painful to touch and the skin over the tendon may be swollen and warm.

Signs and Tests:

On physical exam, a doctor will look for tenderness along the tendon and for pain in the area of the tendon when the patient stands on their toes.

Imaging studies can also be helpful. X-rays can help diagnose arthritis and an MRI will demonstrate inflammation in the tendon.

Treatment:

The initial treatment for Achilles tendonitis is with non-steroidal anti-inflammatory drugs (NSAIDs) and physical therapy to both stretch the muscle-tendon unit and strengthen the muscles of the calf. In addition, any activity that aggravates the symptoms needs to be limited. Occasionally, casting is used to immobilize the heel and allow the inflammation to quiet down.

If conservative treatment fails to improve symptoms, surgery may become necessary to remove inflamed tissue from around the tendon and any part of the tendon that has become abnormal.

Prognosis:

Conservative therapy is usually successful in improving symptoms, although they may recur if the offending activity is not limited or if the strength and flexibility of the tendon is not maintained.

When necessary, surgery has been shown to be very effective in improving pain symptoms. However, if pain does not improve with treatment and vigorous activity is continued, the tendon is at risk of completely tearing.

Complications:

The worst complication is tearing of the tendon. This occurs because the inflamed tendon is abnormal and weak and continued activity can cause it to rupture. In this case surgical repair is necessary but made more difficult because the tendon is not normal.

If you have pain in the heel around the Achilles tendon that is worse with activity, contact your health care provider for evaluation and possible treatment for tendonitis.