Achilles Tendonitis

Orthopaedic & Spine Center

 

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Joel D. Stewart, MD

As a busy Foot and Ankle Specialist, the most commonly reported problem by patients in my practice is Achilles Tendon pain.  It’s a very common cause of heel pain, often confused with plantar fasciitis pain. You may understand the Greek hero Achilles’ weakness if you have Achilles Tendonitis. Mythology aside, if you have problems with your Achilles Tendon, you might feel like you have been shot in the heel with a poisoned arrow. But rest assured, I can diagnose and treat the issue and get you back to the activities you want to do.

First, an anatomy lesson.  The Achilles Tendon, aka Calcaneus Tendon, runs up the back of the lower leg, from the heel to mid-calf, where it connects the heel bone to three different muscles, the Soleus, the Plantaris and the Gastrocnemius.  This tendon is one of the thickest tendons in the body and its primary function is to help us push off (think about the stride you make while walking or running to help you envision how it works).  It does not have a good blood supply, which means it can take a long time to heal when injured. Chronic overuse can also contribute to poor healing.

Symptoms of Achilles Tendonitis usually start gradually and include pain, tenderness and swelling around the backside of the heel, not underneath the heel.  Pain tends to be greater upon rising in the morning and at the start of exercise.  Men are typically affected more than women and issues usually arise between 30-50 years of age.  It can be caused by trauma, overuse, lack of or rapid change in exercise,  rheumatoid arthritis, or from taking certain types of medications, such as steroids or fluoroquinolones (antibiotics).

When you come to see me for a consultation, I’ll do a thorough physical examination, ask you to move your foot and observe you as you walk.  I will order x-rays of the area to look for other causes of heel pain, like stress fracture, bone spurs, arthritis of the ankle or other nearby joints.  I’ll also ask you a lot of questions about when the pain started, when is it worse, what helps to ease the pain, have you tried any at home treatments, etc.  I’ll ask about your lifestyle and activity level.  I do this to create a treatment plan that will make sense for you specifically and one that you can realistically complete for the best results.

Treatment for Achilles Tendonitis typically starts with activity modification, (rest if needed, or avoiding high impact activities) , anti-inflammatory medications, Physical Therapy, cold or hot therapy and perhaps a heel lift or arch support.  If we don’t see improvement, I may discuss other options, like platelet rich plasma, and/or topical medications, like nitroglycerine. Sometimes, the tendon is so damaged, surgery is required.  There are many surgical options, and they depend on where your Achilles Tendon is damaged. 

I will do my best to get you better without resorting to surgery and thankfully, most Achilles Tendonitis will resolve with careful adherence to your treatment plan and patience as you wait for the tendon to heal.  If that fails, we will work out the safest surgery and detail a post operative plan to get you better.  Contact the office for an appointment if you would like to get on a treatment path to return to your normal activities. 

 

Make an appointment with Dr. Stewart or another OSC provider by clicking the “Request Appointment” button below or by calling (757) 596-1900.

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