Achilles tendonitis, or achillotendinitis, is the inflammation of the large tendon in the back of the ankle as a result of trauma or overuse.
Achilles tendon tendinopathy is characterized by microlesions, degeneration and sometimes localized swelling of the tendon, resulting in posterior ankle pain.
The susceptibility to this injury increases with age because the tendons lose their elasticity; Occasional athletes are often affected.
The onset can be traumatic or take an insidious course in which the symptoms gradually become more severe.
Tendinitis can occur as a result of sudden trauma to the tendon .
Movements that can cause tendonitis include running, quick changes of direction, kicking, turning, and dribbling.
Achilles tendonitis can be acute or chronic.
It usually affects athletes and adults who have previously had ankle problems; Achilles tendonitis is very rare in children.
As a rule, only one side is affected; tendinitis is rarely bilateral.
If the tendinitis occurs at the bone attachment point of the Achilles tendon, it is referred to as enthesitis or insertion tendinitis.
Many doctors believe that the pain is caused by the acute inflammation, but the main problem is actually tendinosis.
This condition is the result of many micro-injuries to the tendon accumulated over the years.
Inflammation can develop gradually and be characterized by an imbalance between micro-injuries and tendon repair . In this situation, the tissues are subject to many changes, such as the degeneration of the mucous membranes and the formation of calf deposits . These changes occur when the tendon is overstretched.
Achillotendinitis differs from tendinosis because the latter is not characterized by acute inflammation.
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Achilles tendon anatomy
The Achilles tendon is a fibrous tissue that connects the heel to the lower muscle bellies of the leg, the biceps (gastrocnemius) and the soleus.
The tendon originates on the posterior surface of the heel bone and forms the insertion of the biceps calf muscle.
It is the thickest and strongest tendon in the body.
The Achilles tendon with soleus complex is called the “three-headed calf muscle complex”.
The Achilles tendon is surrounded by a skin (tendon sheath) that protects and nourishes the tendon.
Causes of Achilles tendonitis
The most common causes of tendinitis are overexertion at work, sports and leisure time or a jerky movement.
Tendonitis usually occurs in people who perform repetitive movements at work or during sports.
Achillotendinitis often affects people who jump a lot and run up and down hills.
Wearing flat, heelless shoes and very hard soles can also be a cause.
Risk factors include:
- age (adults and the elderly have less elastic tendons);
- rheumatoid arthritis and lupus;
- Diabetes;
- gout (resulting in a buildup of uric acid crystals in the tendon sheath);
- incorrect technique when performing a sports movement;
- Deformity (bow-legs or knock-knees, dysmetria of the limbs).
Signs and symptoms of Achilles tendonitis
Tendinitis causes discomfort and swelling of the affected tendon.
The symptoms worsen when the tendon is put under tension, ie when the affected limb or joint is moved.
The symptoms can also occur during periods of rest and can sometimes be very limiting.
The muscles that attach to the tendon become weak.
Severe tendinitis can lead to restricted movement and the painful area is very sensitive to pressure.
Diagnosis of Achilles tendonitis
The doctor must examine the patient’s medical history and identify risk factors that may be present, such as exercise or work-related activities that involve frequent repetitive movements.
The doctor needs to know if the pain is due to direct trauma , what the symptoms are, when and how long they have been occurring, and what type of pain is being felt.
Physical exam
First, the doctor examines the area of pain and tries to see if the tendon appears thicker—in some cases, a 1-2 cm “lump” forms; then he presses on the tendon in question in order to be able to precisely localize the symptoms.
There is a specific test for Achilles tendonitis: with the ankle in dorsiflexion (foot raised), the patient must press with the toe against the doctor’s hand resistance and bring the foot into plantar flexion (toe away from the body).
The test is positive if there is pain in the Achilles tendon.
The doctor must look for signs of stiffness because the symptoms can result from a joint impairment.
To rule out a pinched nerve, the doctor will also need to check tendon reflexes.
Differential diagnosis
The doctor must rule out the following diseases:
- osteoarthritis of the ankle
- tibia fracture
- Pinching of the posterior interosseous nerve
- Bursitis of the heel (retrocalcaneal bursitis)
- Deep vein thrombosis (DVT)
- Compartment-Syndrom
- Muscle strain or tear of the biceps or soleus of the calf
- Haglund deformity
- gout
- Fibula tendon rupture
- Cube Leg Syndrome
Technical investigations
Diagnostic imaging tests are not usually necessary to diagnose and initiate treatment for tendinitis when it is caused by overuse.
The doctor may recommend anX-rayto rule out other conditions, such asarthritisorfractures, but tendons and muscles aren’t visible on the X-ray.
A skeletal muscle ultrasound can be useful to show tendonitis; it then indicates a thickened and possibly torn tendon (partial lesion).
In addition, an ultrasound shows real-time images of the tendon as it moves.
Magnetic resonance is the best form of examination because it shows tendon swelling and other problems such as arthritis, calcifications , tumors, etc., but it is rarely performed.
