Achilles Tendinitis

Achilles Tendinitis Overview

Achilles tendinitis refers to inflammation and degeneration of the Achilles tendon, which connects the calf muscles to the heel bone. It is a common cause of pain and stiffness in the back of the ankle, particularly in runners, active individuals, and middle-aged people who increase activity suddenly.

Achilles tendinitis can occur in two forms:

• Non-insertional: affects the middle portion of the tendon

• Insertional: involves the area where the tendon attaches to the heel bone

Both types can cause discomfort, swelling, and activity-limiting symptoms.

Achilles Tendinitis Symptoms and Diagnosis

Common symptoms include:

• Pain and stiffness in the back of the heel or lower calf, particularly in the morning

• Tenderness and swelling along the tendon

• Pain that worsens with walking, running, or climbing stairs

• A thickened or nodular tendon (especially in chronic cases)

• Insertional pain may also involve bony prominence or spur at the heel

Diagnosis is made by clinical examination and confirmed with imaging:

• Ultrasound shows tendon thickening, degeneration, and inflammation

• MRI may be used in long-standing or complex cases to assess tendon integrity and detect partial tears or insertional spurs

Achilles Tendinitis Causes

• Sudden increase in physical activity or training intensity

• Poor footwear or running technique

• Tight calf muscles and reduced ankle flexibility

• Overuse in sports with repetitive jumping or running

• Underlying foot biomechanics (e.g. flat feet or high arches)

• Age-related tendon degeneration

Achilles Tendinitis Treatment and Prevention

In most cases, Achilles tendinitis can be treated without surgery. Management focuses on reducing inflammation, restoring flexibility, and strengthening the tendon.

Conservative treatments include:

• Activity modification and rest from aggravating activities

• Ice and anti-inflammatory medication

• Heel lifts or orthotics to reduce tension on the tendon

• Eccentric calf strengthening exercises (Alfredson protocol)

• Physiotherapy for stretching and rehabilitation

• Extracorporeal Shockwave Therapy (ESWT):

A non-invasive treatment that uses sound waves to stimulate healing and tendon regeneration. ESWT is often effective in chronic cases and can help avoid surgery.

Night splints or taping techniques may also be used. Stretching of the gastrocnemius muscle (upper calf) is an important part of physiotherapy.

Achilles Tendinitis Surgery

Surgery is reserved for patients who fail to respond to a full course of conservative care, including shockwave therapy and physiotherapy.

Surgical options may include:

• Debridement of degenerated tendon tissue

• Removal of retrocalcaneal bursae or calcific spurs in insertional tendinitis

• Tendon reinforcement or augmentation if significant degeneration is present

• Proximal medial head of gastrocnemius recession:

If tightness in the calf muscle is contributing to excess load on the tendon (equinus), a small surgical release of the medial gastrocnemius can reduce tension and improve flexibility. This is commonly performed in conjunction with other procedures.

Mr Hester will discuss the specific surgical plan with you, including whether gastrocnemius recession or tendon debridement is appropriate based on your symptoms, imaging, and response to non-operative care.

Post-operative recovery will vary based on the exact procedure performed but generally includes:

• Initial rest and elevation of the foot with a bulky dressing or cast

• Protected weight-bearing in a boot for 6–8 weeks

• Wound review at 2 weeks with suture trimming or removal

• Physiotherapy begins after initial healing to restore range of motion and strength

• Full return to sport may take 4–6 months depending on healing

If gastrocnemius recession is performed alone, recovery is often quicker, with walking in a boot from 2–3 weeks and return to shoes by 6 weeks.

Expected Recovery Timeline

0–2 weeks

Rest, bulky dressing or back slab. Foot elevated. Non-weight-bearing.

2 weeks

Wound review. Sutures trimmed. Transition to boot if not already in one.

2–6 weeks

Gradual weight-bearing in boot. Gentle movement begins.

6–12 weeks

Begin physiotherapy. Wean out of boot. Swelling improves.

3–6 months

Progressive return to full activity. Sport-specific rehab.

6–12 months

Full recovery and return to impact activity depending on healing and function.