Do you sometimes wake up in the morning with a sharp pain in the back of your leg, just above your heel? Does this pain seem to get worse when you walk up a flight of stairs or even walk briskly? Then you may have Achilles Tendinitis, a condition that is common in athletes and those who are constantly active. Don't worry, this is something that happens to many people. Let's talk about it all in simple, clear terms.
What is Achilles Tendinitis?
Simply put, Achilles tendinitis is an inflammation, or swelling, of the tendon in your shin. Now look, there's a very strong piece of tissue at the back of your leg, right at the shin. This is what we call the Achilles tendon . This is what connects our calf muscle to the heel bone. It's the Achilles tendon that helps us raise and lower our foot when we run, jump, and walk.
Now imagine that you run every day, or play a sport that puts a lot of strain on your legs. When you put a lot of strain on this tendon without rest , it gradually becomes injured and starts to swell. That's what we call Achilles tendinitis. In medicine, inflammation is a normal response of our body to an injury or illness.
Are there main types of Achilles Tendinitis?
Yes, there are two main types of this condition depending on where it occurs. It is important to know this, as treatment options can sometimes vary.
| Type | Simple explanation |
|---|---|
| Noninsertional Achilles tendinitis | This causes the delicate fibers in the center of the hair to break, swell, and thicken. This type is most common in very active, young people. |
| Insertional Achilles tendinitis | This affects the lower part of the heel where the heel bone connects to the heel bone. It can happen to anyone, even someone who is not very active. But it is most common in people who overuse the heel, such as long-distance runners. |
What are the symptoms? How do you recognize this?
If you have this condition, you will usually see these symptoms. See if you have one or more of these too.
- Heel and ankle pain: Pain is felt along the shinbone, especially just above the heel.
- The leg feels stiff or painful to the touch: You may feel so stiff that you can't put your leg down when you wake up in the morning.
- Leg weakness: Your leg may feel weak.
- Swelling around the Achilles tendon: The area may feel swollen when you touch it.
Times when pain may increase
Sometimes this pain is not always the same. The pain may increase in cases like these:
- After you finish exercising or the day after.
- When climbing stairs or climbing a high place like a mountain.
- You feel severe pain when you wake up in the morning, and the pain gradually decreases as the day goes on.
Why does Achilles Tendinitis occur? Who is at higher risk?
The main cause, as we discussed earlier, is overuse of the Achilles tendon and not enough rest to allow it to heal. This is usually not a one-time injury, but rather a result of repeated stress on the tendon over a long period of time.
Who is at higher risk?
Although this condition can develop in anyone, some people are at higher risk.
- Athletes: Especially those who play sports that require sudden stops, runs, and changes of direction (e.g. cricket, netball, basketball).
- Runners and dancers: This is very common for long-distance runners.
- People who work in jobs that put a lot of strain on their legs: For example, those who work in the construction industry.
- "Weekend Warriors": These are people who work in the office five days a week and then go out to play cricket or run on the weekends. Their bodies are not used to such sudden exertion, so they can easily get injured.
Does body shape also affect it?
Yes, sometimes the natural position of our body can also be a reason for this.
- Tight or weak pelvic muscles.
- Having an extra bone spur in the heel: This extra bone spur can cause pain when it rubs against the heel.
- Flat arches.
- Overpronation (rolling of the ankles inward) when walking.
What can happen if left untreated?
This is a mistake that many people make. They think, "It hurts a little, it's okay, let's run a little longer." But if you ignore this pain, the situation can become much more serious.
1. Achilles tendinosis: This is when the tendon goes beyond inflammation and begins to degenerate . The tendon fibers become weak, increasing the risk of rupture.
2. Achilles tendon rupture: This is the most serious thing that can happen. It means the tendon is completely torn or ruptured .
This is a medical emergency. If the tendon ruptures, you may feel a popping sound. You may then be unable to put your leg down. If this happens, you should go to the nearest hospital's Emergency Department (ETU) immediately.
Doctor, how exactly do you find this?
When you go to see a doctor, he will first ask you about your symptoms and your activities. Then he will do a physical examination to see if the area is swollen or painful to the touch.
Most of the time, this test can diagnose the condition on its own. However, sometimes the following tests may be done to determine the severity of the condition or to rule out other problems:
- X-ray
- Ultrasound scan
- MRI scan
- CT scan
What are the best treatments?
The good news is that most of the time, this doesn't require surgery. But it does require patience and treatment. It can take several months for the pain to completely go away.
Nonsurgical Treatments
First, the doctor recommends things like this. We also call this the RICE method .
| Method | What to do |
|---|---|
| R - Rest | Avoid activities that put pressure on the knee (running, jumping) completely. Instead, do exercises that don't put weight on the leg, like swimming. |
| I - Ice (Icing) | Apply ice to the painful area for about 20 minutes several times a day. Do not apply the ice directly to the skin, wrap it in a towel. |
| C - Compression (applying pressure) | To reduce swelling, wrap the area tightly with something like a crepe bandage. |
| E - Elevation | To reduce swelling, when you are lying down, keep your legs elevated above your heart, with two or three pillows. |
Other treatments
- Wear good shoes: Don't walk around barefoot. Wear shoes with a slightly higher heel that provide good support for your feet. Your doctor may recommend heel lifts or custom orthotics (a shoe insert made specifically for your foot).
- Painkillers: You can take NSAIDs, such as ibuprofen. But remember, don't take these medications continuously for more than a month without consulting your doctor.
- Physical Therapy: This is very important. A physical therapist will teach you exercises to strengthen your hip muscles and stretching exercises.
- Shockwave therapy: This uses powerful sound waves to reduce pain and speed up healing.
When is surgery necessary?
If you have tried these other treatments for about 6 months and the pain has not subsided, your doctor may consider surgery. There are several types of surgery. The most appropriate surgery will depend on the severity of your condition, your age, and your activity level.
- Gastrocnemius recession: A surgery to lengthen the gastrocnemius muscle.
- Debridement and repair: Removing damaged parts of the tendon and sewing back together healthy parts.
- Debridement with tendon transfer: If more than 50% of the tendon is damaged, another tendon (e.g., the tendon that bends the big toe downward) is taken and transplanted to the damaged area.
How can this situation be prevented from occurring?
"Prevention is better than cure," they say. So if you keep these things in mind, you can avoid this painful condition.
- Warm up well before exercising: Don't start running right away. Warm up for about 5-10 minutes.
- Stretch your hamstrings regularly: Do exercises that stretch your hamstrings well before and after exercising.
- Add variety to your workouts: Instead of running every day, if you run one day, cycle another day, and swim another day, you'll stop putting pressure on the same joint.
- Gradually increase the intensity of your exercise: Don't try to run 10 kilometers all at once. Increase the distance gradually.
- Wear good shoes: Use a pair of shoes that are appropriate for the sport you play and provide good support for your feet.
- Reduce running on hills and uneven terrain.
The most important thing is to listen to your body. If you feel pain, don't ignore it. Stop and rest.
Take-Home Message
- Achilles tendinitis is an overuse injury to the tendon. It doesn't happen overnight.
- If you feel pain, rest is the best medicine . Don't exercise when you're in pain.
- If treatment is started early, the healing process will be much easier and faster.
- This condition can be prevented by simple things like wearing good shoes and stretching before and after exercise.
- If the pain does not subside within a few weeks, if the pain is severe, or if you hear a 'clicking' sound from the ear, see a doctor immediately.
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