Joint Replacement Institute

Achilles Tendonitis | Bonita Springs

Foot Pain Specialties

As the largest tendon in the body, the Achilles tendon is found along the back of the ankle and foot, connecting the calf muscle to the heel bone. Able to withstand large amounts of movement-induced stress, this tendon is used when walking, running, and jumping. In cases of overuse, progressive wear-and-tear may lead to the development of tendonitis, which causes significant pain and discomfort along the back of the leg. In addition to degenerative damage, single traumatic injuries may also lead to the need for Achilles tendon care.

The Types of Tendinitis

Tendinitis refers to the swelling of a tendon, which is directly caused by either injury or disease. Symptoms include inflammation, pain, and general irritation, and often impact one of two areas of the Achilles tendon. While non-insertional Achilles tendinitis affects the mid-portion of the tendon, insertional Achilles tendinitis is found in the lower area of the heel.

Younger, active patients are the most susceptible to the non-insertional form, as it is often directly related to exertion-based damage. In either form, damaged tendon fibers may harden (or calcify) causing discomfort and a visibly thickened heel. Patients suffering from insertional tendinitis often display the formation of bone spurs as well.

Causes of Achilles Tendon Damage

While single injury events may result in Achilles tendon damage, cases of tendinitis are typically the result of repetitive stress. Athletes and those starting new physical fitness routines may be especially at risk, as they have a higher likelihood of attempting to increase workout intensity at a rapid pace. In addition to increasing exercise activity without providing the body the chance to adjust, other causes of tendinitis include tight calf muscles (which exert extra stress on the Achilles tendon) or the presence of bone spurs on the heel (which can rub against the tendon and cause pain).

In a case of Achilles tendinitis, you may experience any or all of the following symptoms:

Pain and stiffness along the ankle back and heel
Exercise-induced ankle and heel pain
Thickening of the tendon
Bone spurs (in the case of insertional tendinitis)
Consistently-present inflammation and discomfort

If you are exhibiting any of the above symptoms, you will want to visit your orthopaedic surgeon for a full assessment of Achilles tendon health. Should you experience a sudden 'pop' in your calf or heel, you should seek medical care immediately, as you may be suffering from an Achilles tendon tear.

Examination and Surgery

To fully assess the cause and severity of your Achilles tendon injury, your orthopaedic surgeon will likely employ the use of x-ray and/or MRI tests. In cases of tendinitis, it will be important to diagnose whether calcification or bone spurs are present, and if so, the specific damage location. In cases of severe tendinitis or injury-related damage, these exams will play an integral part in determining the best approach for procedural intervention.

For successful treatment of tendinitis, your orthopaedic surgeon may prescribe non-invasive treatment approaches, including the use of exercise, anti-inflammatory medication, cortisone injections, or orthotic devices. If symptoms do not show improvement within six months, surgical intervention will often be recommended. In the most cases of advanced damage, one of following operations may be utilized:

Gastrocnemius recession
Debridement and repair
Debridement and tendon transfer

Gastrocnemius Recession and Debridement

Gastrocnemius recession involves the surgical lengthening of one's calf muscle in order to relieve stress on the Achilles tendon and enable foot flexion. While this operation can be performed via a traditional, open incision, your orthopaedic surgeon may be able to provide an arthroscopic alternative in select treatment cases.

Debridement involves the removal of any damaged portions of the Achilles tendon. In cases of less than 50% tendon damage, the remaining tissue will often be sutured in order for successful healing, with the patient wearing a boot or cast for 2-3 weeks. If tendon damage is more extensive, a full transfer may be executed. In cases of Achilles tendon transfer, the removed component will be replaced through the relocation of the tendon that enables your big toe to point downwards.

Dependent upon your specific surgical need and level of intervention, your orthopaedic surgeon will advise the best recovery plan. Many patients will require up to a year of physical therapy in order to fully relieve pain and restore function. While the risk of complications is minimal in Achilles tendon operations, if you experience unusual pain, inflammation, or another symptom of concern, you should contact your physician immediately. In the most severe cases of tendon damage, you may be advised to avoid a return to competitive sports or running.

Dr. Weaver is experienced in the diagnosis and surgical treatment of Achilles tendon injuries. To schedule an appointment, contact either the Joint Replacement Institute's Naples office at 239-261-2663, or her Bonita Springs office at 239-676-2663.

Naples: 1250 Pine Ridge, Suite #3 • Phone: (239) 261-2663 • Fax: (239) 262-5633

Bonita Springs: 3501 Health Center Boulevard, Suite #2180 • Phone: (239) 676-2663 • Fax: (239) 676-2655