Dollar bills are made of 75 percent cotton and 25 percent linen—they’re pretty strong. However, with repeated handling, they can become worn and more likely to rip, compromising the whole structure. The same goes for the Achilles tendon: It’s strong but can become inflamed and even tear from overuse, a condition that we like to call Achilles tendinitis or the broader term, Achilles tendinopathy.
In our office, we use this term to refer to most Achilles pain, even though tendinitis is only the acute state that is more representative of the inflammatory stage. Tendinitis is inflammation of the Achilles tendon that runs along the back of your heel, connecting the calf muscle to the heel bone. If you have chronic inflammation, it can weaken the tendon and may develop into tears in the tissue. Tendinosis is the technical term to describe those tears, but both forms of heel pain fall under the more broad term of Achilles tendinopathy.
There are many places where you can experience pain in the Achilles. When your discomfort is at the base where it is attached to the heel, it’s called insertional Achilles tendinitis. You can also get pain in the middle of the tendon, called noninsertional Achilles tendinitis.
This refers to the chronic state of inflammation where there is actually a change in the tendon substance itself. After inflammation sets in due to overuse, the tissues in and surrounding the tendon can change and develop tiny rips. Sometimes the disease progresses and one is highly vulnerable to an Achilles tendon tear or rupture. In a mild case, the tear may cause no pain at all. However, a complete tear will create loss of movement, strength, and a whole lot of pain.
Most of the time, inflammation and tears aren’t bound to one specific cause; it’s usually due to overuse and repetition of the same movement. Sudden increases in activity that tighten your calf muscles can also be a contributor to pain—the same goes for bone spurs on the back of your heel. Even at times, calcifications can grow within your Achilles tendon near its insertion. This is called Achilles insertional calcific tendinosis.
Paying Up with Pain
No matter which area it occurs, the pain in the back of your leg near the heel might start as an ache after activity. Then, the tendon will start to feel very tight when you wake up and try to walk on it. If you reach down, you might be able to feel pain, thickness, and swelling around the area.
Soon enough, you’ll feel constant pain throughout your workout. The swelling will also get worse as the day goes on. You’ll start waking up with severe pain that lasts the whole day, especially on days after a workout. In some cases, you might hear a popping noise—most likely a rupture. See a doctor immediately.
Show Me the Treatment
Rest is going to be the most important initial treatment method. Ice the area for 20 minutes at a time to relieve pain and swelling. During this time, you might want to buy a new pair of shoes if your existing pair isn’t controlling your motion or supporting your heel enough.
A podiatrist like Dr. Brian McDowell or Dr. Gavin P. Ripp can prescribe custom orthotics that can take some stress off of the area while also allowing some movement to retain flexibility. They can also instruct you on proper stretching exercises which is the mainstay of treatment. Additionally, we can show you how to tape the tendon while you’re rehabilitating. We might suggest that you try oral anti-inflammatory medications, coupled with some more advanced treatments like physical therapy, heel lifts, sports massage, injections, or a cast.
If we haven’t seen you improve after a few months, we’ll talk to you about surgical options. In advanced stages of tendinopathy, patients are more recalcitrant to conservative care and often will require surgery at some point. The earlier you treat the discomfort the easier it is to reverse the symptoms which would prevent surgery.
If Achilles tendinopathy has you hurting, don’t hesitate to call our heel pain specialists in Carmichael, CA, at (916) 961-3434. The McDowell Podiatry Group is committed to giving you the best care out there. Our office, which serves the greater Sacramento area, can also be found on Facebook, Twitter, and Pinterest! Follow us today and find relief for life!