The Achilles tendon is a large tendon in the back of the lower leg that attaches to the heel bone. Achilles tendinitis is where this tendon becomes irritated or inflamed and causes pain. Achilles tendinitis is a very common FOOT AND ANKLE condition.
Some interesting facts regarding the Achilles tendon include the fact that the Achilles tendon happens to be the largest and strongest tendon in the human body. It is capable of withstanding forces up to 1000 pounds or more during activities like running or jumping. This tendon was named after mythology specifically the Greek hero Achilles, who’s only vulnerable spot was his heel.
The purpose of the Achilles tendon is to aid in ambulation. A tendon is a structure that attaches from a muscle to a bone. So as the calf muscle, also known as the gastrocnemius and soleus, contracts this will pull the Achilles tendon upward or proximal which intern causes a downward or plantar flexion of the foot. This will create a propulsive force allowing us to move forward.
Certain sections of the Achilles tendon have a poor blood supply which lends to its regenerative challenges. Unlike muscles, the Achilles tendon has limited regenerative capability, which is why recovery from tears and ruptures often require prolonged rehabilitation or sometimes surgery.
There are two types of Achilles tendinitis known as insertional or non-insertional. Insertional, as the name applies, is where the pain is at the insertion of the tendon onto the heel bone. Non-insertional Achilles tendinitis, sometimes known as tendinosis, happens more proximal in a section of the tendon 2 to 6 cm above the heel. This is the vulnerable area of the tendon due to its poor blood supply.
Risk factors for Achilles tendinitis
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- Overuse
- Sudden increase in activity
- Tight calf muscle, also known as equinus.
- Poor footwear
- Flat feet
- Age
- Inadequate, warm-up or stretching
Treatment for Achilles Tendinitis
Treating a painful Achilles tendon can sometimes be challenging. One of the main treatments is to wear a structurally supportive shoe with a sturdy heel counter however sometimes the heel counter of the shoe can cause increased pain due to pressure.
When using a shoe to help with Achilles tendinitis, it’s important to address the pain at the same time. Sometimes anti-inflammatories, either oral or topical, and certainly ice can be very beneficial to reduce inflammation and pain. The reason a supportive shoe is important in helping relieve the tendinitis is due to the fact that the more support the shoe provides the less work the tendon does. This is the same reason that arch supports or orthotics are recommended. An arch support can reduce or diminish, abnormal or excessive motion of the foot which again allows the tendon to rest. Heel lifts are also recommended. A heel lift can elevate the heel relative to the forefoot which will then cause relaxation of the Achilles tendon, which makes it easier for the tendon to heal. A soft elastic ankle sleeve can also help by again, slowing down, excessive or abnormal motion of the FOOT AND ANKLE thereby allowing the tendon to rest. Other treatment options include ice, rest, anti-inflammatories, and physical therapy.
In summary, understanding the mechanics and how the tendon actually works will aid in your ability to resolve the problem. It’s also important to take proactive steps, like stretching, supportive shoes and arch supports, to keep your Achilles tendon healthy and prevent this condition from happening in the first place.
Written by
Dr. Jeffrey S. Hurless
DPM, FACFAS Board Certified Foot & Ankle Surgeon/Podiatrist
Medical Director, HealthyFeetStore.com
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