Pain in the back of the ankle can be a major problem to both the athletic and non-athletic populations. Although more commonly seen in athletes, achilles tendinitis can be seen in patients of all ages and athletic involvement. Most patients present with pain in the back of the heel or in the cord like structure right above the heel. This cord is known as the achilles tendon. The achilles tendon itself is a conjoined tendon of the gastrocnemius (large calf muscle) and the soleus (smaller calf muscle under the gastroc).
Achilles tendinitis is often caused by a tightness in the Gastoc-Soleal complex. Tight calf muscles lead to the tendon becoming overly stretched; this in turn causes small tearing in the tendon. These microscopic tears heal in a scar formation causing pain. Chronic tendinitis and tearing can lead to tendinosis or thickening of the tendon and ultimatly tendon rupture if left un-treated.
Treatment for tendinitis and tendinosis depends largely on how much tendon is involved, amount of pain, and activity level. Patients who are highly active require more aggresive treatment, while less active patients may improve with basic physical therapy. Here are some treatments we do for the problems.
-Steroids: Oral steroid can be used to reduce pain and inflammation in the tendon. It is important when taking steroid to decrease activity as they may weaken the tendon and increase the chance of tendon rupture.
-Stretching: Stretching is often perscribed for treatment of achilles tendinitis. This helps relieve the pressure on the tendon by lengthening the muscles. Stretching devices such as night splints may be given as part of this treatment.
-NSAIDs: Non-Steroidal Anti-Inflammatory Drugs are often used to help reduced the overall inflammation in the tendon. Oral tablets may be perscribed or topical applications may be dispensed.
-Immobilization: Some patients require immobilization to offload the tendon and allow healing. This is usually in the form of a walking boot, but a cast may also be used.
-Orthotics: Shoe inserts can help to raise the heel and decrease pressure on the tendon. Heel lifts may also be used to relieve the pressure temporarily.
-Amniotic Injections/PRP: Amniotic injections or PRP may be used to help to repair the injured tissue. These injection are anti-inflammatory, but also contain growth factors to help repair the tissue. Steroid injections may also be recommended, but should be used as a last resort as thy can weaken the tissue and have a higher risk of tendon rupture.
-Surgery: When all else fails, there are surgical options for tendinitis/tendinosis. Surgery is dependent on the area of pain, activity level and pathology. Minimal invasive surgeries can be performed using ultrasound debridement of the tendon with relatively quick recoveries. Tendon lengthening procedure may be indicated. "Debulking" procedures are also an option in the case where the tendon has become overly thickened.
Likely your Podiatrist will recommend a combination of the above therapies. There is no one size fits all treatment for any foot or ankle problems. The achilles tendon is a complex structure and essential for walking, running and jumping.
Chris Suykerbuyk, DPM, FACFAS