Achilles’ Tendon Disorders

The Achilles’ tendon is the largest and strongest tendon in the body.

Lets start with some basic anatomy. Another name for this tendon is the triceps surae. The reason for this is because there are three muscle in the back of the leg that contribute to formation of this tendon. These include the gastrocnemius muscle (see my blog post on heel pain and the utility of the Baumann procedure), the soleus muscle and the plantaris muscle (not everyone has this muscle). The gastrocnemius, soleus and plantaris give rise to tendon fibers that ultimately coalesce into the Achilles tendon. The tendon eventually attaches to the middle 1/3rd of the heel bone/calcaneus.

Two common conditions seen at District Foot and Ankle in Alexandria, Virginia include insertional and non-insertional achilles’ tendonitis (or tendinopathy).

The difference between insertional and non-insertional refers to the anatomic location where the tendonitis occurs. Insertional tendonitis of the achilles’ tendon occurs where it attaches to the calcaneus/heel bone. Non-insertional achilles’ tendonitis occurs at a point away from the attachment site into the calcaneus (ie “proximal” to the insertion point).

Achilles tendinopathy is an overuse injury in most instances. There are other causes of tendinopathy but are much rarer. One example would be a potential complication from the use of fluoroquinolone antibiotics (like ciprofloxacin or levofloxacin). Repetitive activity puts undo stress on the tendon and leads to inflammation and degeneration of the tendon fibers. Due to the repetitive stress, the body is unable to keep up with repair and the tendon structure becomes altered. Clinically, this can manifest as a thickened/enlarged tendon.

Athletes and weekend warriors are at particularly higher risk for developing achilles’ tendon disorders.

Symptoms of achilles’ tendonitis include pain, soreness and stiffness of the tendon. As the condition progresses, the tendon can become thicker and enlarged, as mentioned above.

Diagnosis should be made by your foot and ankle specialist. The diagnosis is made through a thorough medical history and clinical examination. Additional modalities may be employed including ultrasound examination and possibly MRI in more advanced or chronic cases, especially if any tearing or rupture is suspected.

Treatment is typical for that of other overuse injuries. Rest, ice, activity modification, anti-inflammatories/Tylenol, physical therapy and stretching. There is a particularly useful stretch used for achilles’ tendonitis called the “eccentric muscle contraction”. This is the opposite of a “concentric” muscle contraction.

What’s the difference between a concentric and eccentric muscle contraction?

For a concentric muscle contraction, visualize your arm lifting a heavy bucket of water. As the biceps muscle contracts, the angle between your forearm and upper arm decreases in size and the muscle fibers of the biceps shorten.

An eccentric muscle contraction would be the opposite. Think about the bucket of water being lowered by your arm. As this occurs, the biceps muscle fibers are still activated; however, the angle between the forearm and your upper arm is increasing in size and the muscle fibers are elongating.

An eccentric muscle contraction is a very useful treatment modality for achilles’ tendonitis especially the non-insertional subtype. This can be achieved by raising both feet/standing on your toes (ie plantarflexing at the ankle joint), then lifting the foot up into the air that is healthy and slowly lowering the afflicted extremity. Check out this video for a good visualization of the technique.

In summary, Achilles’ tendinopathy is a very common condition seen in the athletic population and in weekend warriors and is commonly treated by Dr. Nodelman at District Foot and Ankle. I would recommend setting up a formal evaluation before implementing any at-home treatment protocols to confirm the diagnosis. Dr. Nodelman has access to in-office digital x-ray and ultrasound to help further clarify the diagnosis and can make arrangements for advanced studies (like MRI) if needed. Additionally, advanced treatment protocols can also be implemented such as Radial Shockwave Treatment.

Call to schedule an appointment today to evaluate your Achilles’ tendon!