Achilles tendinitis, sometimes called tendinitis of the heel, is a repetitive stress injury of the Achilles tendon, a band of tissue that connects the calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus) at the back of the lower leg. When the tendon becomes inflamed due to repetitive strain from running and jumping, increases in physical activity may become painful. Without proper healing and treatment, Achilles tendinitis may become a chronic and degenerative condition in which partial tearing and thickening of the tendon occurs due to scar tissue buildup. This more advanced condition is often called Achilles tendinosis.
Although the Achilles tendon is the thickest and strongest tendon in the body, it is frequently injured or ruptured due to excessive strain and its limited blood supply. The Achilles tendon can receive the stress of 3.9 times a person’s body weight during walking and 7.7 times a person’s body weight during running. This tendon is used when walking, running, and jumping, and when pointing or rising up on the toes. There are two forms of Achilles tendinitis: non-insertional, in which the inflammation is in the middle portion of the tendon, and insertional, which occurs at the heel where the tendon connects (inserts) to the bone. Non-insertional Achilles tendinitis tends to occur due to excessive strain and activity, and is therefore more prevalent in younger, more active people. Insertional Achilles tendinitis does not require excessive strain or activity to occur, and is therefore prevalent in less active people of all ages.
Symptoms include pain and swelling in the back of the leg or above the heel, usually during and after activities. Patients might also experience tenderness or stiffness in the morning, which improves with mild activity. Swelling from a lumpy buildup of scar tissue on the tendon may be detected visually or by touch.
The Achilles tendon receives a lot of stress both in movement and weight-bearing activities. Overuse and the limited blood supply to the tendon from just one blood vessel, the posterior tibial artery, can cause swelling, irritation, and inflammation. The blood supply is weakest at the Achilles tendon-to-heel connection, which is why Achilles tendinitis and other Achilles tendon problems occur about two inches above the heel. With age, this blood vessel becomes narrow and increases the risk of tendinitis and tearing or rupture of the tendon, especially when Achilles tendinitis goes untreated.
Vascular diseases, damage in the peripheral nerves resulting in weakness or numbness, and rheumatologic diseases may cause degeneration of the Achilles tendon. Achilles tendinitis is common particularly in middle-age men because the Achilles tendon weakens and loses flexibility with age. This form of tendinitis is also common in people who play sports only on the weekends, as the lack of consistency in activity strains the tendon. Having flat foot arches or tight calf muscles, and running in worn-out shoes or on hard, slippery surfaces can increase strain on the Achilles tendon. Tendon pain occurs more frequently in cold weather than in warm weather. People with diabetes or high blood pressure are at higher risk of developing Achilles tendinitis. A bone spur formed on the back of the heel bone may also irritate or cause pain and swelling to the Achilles tendon.
- Wear supportive footwear. Your body’s overall alignment begins at the feet. When the feet are not properly aligned, consequences (like pain and injuries) can occur in the feet, ankles, legs, knees, and hips. The wrong footwear can compromise your foot alignment, potentially leading to maladies like Achilles tendinitis. If you run or walk often, get professionally fit for running sneakers. And minimize the amount of time you spend in non-supportive or Achilles tendon-straining shoes like flats, flip-flops, or high heels.
- Use compression socks. Achilles tendinitis is sometimes due to lack of circulation in the lower legs and ankles, and becomes more common with age. Compression socks help to increase blood flow to the legs, ankles, and feet, which keeps the Achilles tendon flexible, strong, and healthy. If you’re not used to wearing compression socks, start for a short period of time and work your way up. They are particularly useful during exercise and when you expect to be seated for long periods of time (like when on an airplane).
- Stay fit. Achilles tendinitis is often an overuse injury, so it may seem counterintuitive to focus on exercise. But the body functions best when taken care of. Consistent exercise is important for maintaining circulation throughout the body and strengthening the muscles in the legs and feet that support the Achilles tendon. If you suspect you are developing Achilles tendinitis, simply change your type of exercise. For example, if you are a runner, try riding a stationary bike or swimming for a while. But avoid drastic changes in your fitness level. To illustrate, if you try to run a half marathon without training for it, your chances of injury drastically increase. Regular exercise that gradually builds in intensity and duration yields the best results.
1. Ground the Feet. Achilles tendinitis is often the direct result of improper foot and ankle alignment. For example, if someone puts excess pressure on the toes and little pressure on the heels, the Achilles tendons experience excess strain. Grounding the feet ensures that your weight is distributed evenly along the bottom of the foot to improve foot and ankle alignment, and thus reduces the risk of developing Achilles tendinitis. To Ground the Feet, first create equal pressure on the left and right foot. Then, imagine points at the base of your big toes, pinky toes, outer heels, and inner heels. Pull the toe stems long and push all four points of the soles into the ground. In everyday life, you can Ground the Feet when you stand in line at the grocery store, brush your teeth, or sit at your desk at work. No matter if you’re seated or standing, connect to the ground beneath you by simply pressurizing through the four points of the soles with equal weight on both feet, and reach long through the toes.
2. Stabilize the Knees. When dealing with a potential injury, be sure to assess not only the affected joint but the surrounding joints as well. While the feet are important for proper ankle alignment, so are the knees. Stabilizing the knees will further improve alignment in the ankles and strengthen the leg muscles that support the Achilles tendon, thus reducing the risk of developing Achilles tendinitis. To Support the Knees, imagine a point at the center of each kneecap. Standing naturally, observe whether these points face directly forward or off to the side. Now, adjust the feet so they are parallel, and align the kneecaps directly forward—this will be roughly in line with your middle toes. As you bend your knees, challenge yourself to keep the knees stacked directly above the ankles, with the center of the kneecaps forward. In everyday life, you can Support the Knees while climbing the stairs. Maintain equal pressure on the bases of the big toes and the pinky toes. As you climb the stairs, face the hips directly forward, and maintain alignment of the knees directly over the ankles.
3. Anchor the Hips. The Achilles tendon bears a lot of weight during activities like walking or running. When the hips are misaligned, the pressure on the Achilles tendon may increase beyond its intended capacity. By anchoring the hips, you improve hip alignment and stability, thus reducing excess strain on the legs, knees, ankles, and feet and minimizing the risk of Achilles tendinitis. To Anchor the Hips, make “L” Mudra with your hands. Place your thumbs on your ribs and your index fingers on your hips. The space between the thumbs and the index finger is called the side body. This area shortens when you slump or slouch. Increase the space between the index fingers and thumbs to lengthen the side body. Now, draw the lower belly—the space between the belly button and the pubic bone—back toward the spine and up toward the ribcage to engage the deepest layer of abdominal muscle (transverse abdominis). Finally, release the glutes (butt muscles). To learn to release your glutes, it may help to understand what it feels like to do the opposite—grip the glutes. To grip the glutes, squeeze them together. Now release. In everyday life, you can Anchor the Hips when standing from a chair. Before rising, lengthen the side body. On an exhale, Ground the Feet, and simultaneously pull the belly in toward the back and up toward the ribcage, and release the glutes to stand.
RICE. Achilles tendinitis is inflammation of the Achilles tendon. To reduce this inflammation, implement the RICE technique—Rest, Ice, Compress, Elevate. Rest the ankle for a few days before jumping back into any sort of rigorous activities. Apply an icepack to the tendon to reduce swelling after activity or when you experience pain. Wrap an ACE bandage or wear a compression sock during periods of inactivity. Elevate the foot and ankle above the hip whenever possible (like when sleeping or resting) to encourage blood flow away from the affected area.