Achilles Tendonitis is a painful condition of the large tendon on the back of the lower leg. It can be from inflammation or an actual degeneration of the tendon itself.
The Achilles tendon consists of one tendon that originates from two muscles, the Gastrocnemius muscle and Soleus muscle. The muscles attach to the tendon that inserts to the lower aspect of the back of the heel (Calcaneus). Fibers of the tendon attach around the heel to the plantar fascia. The plantar fascia attaches to soft tissue about the base of your toes. Thus, bending the big toe joint affects the plantar fascia, heel bone and Achilles tendon unit.
There are two types of Achilles tendonitis. One type is pain at the Achilles tendon where it attaches to the back of the heel bone. The other is pain above the heel bone within the tendon itself. The latter is typically a result by overuse or sudden tension. For example, a sudden fall or jump. It is important to distinguish the two types as there are different causes and treatments. Pain above the bone is more difficult to treat.
Pain at the back of the heel bone can be from a sudden tension on the tendon as well. However, it typically has a faulty biomechanical cause. This allows the heel bone to move too much causing the heel bone to rub on the shoe or tendon itself. Long term faults can lead to bone spurs on back of heel, a bursitis (fluid filled sac cushioning the tendon from the bone), or Haglund’s Deformity (large protrusion of bone on the back of the heel that rubs on the tendon. This can cause inflammation and pain.
I’ve seen many large boney protrusions on the back of the heel that were not painful. Therefore, a rush to shave this bone down should be addressed nonsurgical first. This type of surgery typically has a long recovery period and should be avoided if possible. If you’re suffering with Achilles tendonitis, the tendon usually becomes inflamed but long term it can deteriorate.
Common non-surgical treatment recommendations such as rest, taping, icing, massage, heel cups/cushions etc. may all be helpful, but they only treat the symptoms. It is important to identify and address any aggravating factors such as faulty biomechanics causing the Achilles Tendonitis. Attacking the cause of pain is the fastest way to recover and prevent the problem from occurring.
David J. Sables, D.P.M., C.Ped
ArchMasters-Orthotics, Shoes & Footcare, LLC