Achilles tendonitis or tendinopathy is an inflammatory process involving the achilles tendon in the back of the ankle. It can develop from overuse of the achilles, or from micro trauma. It is common in athletes and very active people.
Patients complain of activity-related pain along the achilles tendon, either at the junction of the tendon and muscle, or at the attachment point on the heel bone. As the condition worsens, the pain becomes present with daily activities and at rest. It can cause pain at night.
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Examination is characteristic, with pain to touch along the achilles tendon, or with extension of the ankle. There is often swelling or enlargement of the tendon. Raising up on the toes will reproduce pain.
X-rays are not usually helpful, however, an MRI will show swelling in the tendon and can help be sure there is not a tear of the tendon. It can help assess the extent of the damage.
Treatments are typically nonsurgical. Rest, using, stretching, and anti-inflammatories are the starting point. A walking boot will rest the tendon and physical therapy is often helpful. It is hard to rest !!
Injections of platelet-rich-plasma (PRP) for achilles tendinitis have not been shown to be helpful in current studies, however, results are not yet conclusive.
Surgical treatments are very rare. This can be done to excise diseased tissue, or repair torn tissue. The results are mixed with surgery.
The pain from tendonitis can often linger for months. Sticking with the nonoperative treatments are usually rewarding.
Dr. Scott Hacker is a Sports Medicine Orthopedic Surgeon in San Diego, CA, Knee and Shoulder Surgeon, and Principal Investigator for Orthopedic Clinical Trials. He specializes in sports medicine and sports injuries, knee and shoulder surgery.
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