Disease Description (Causes and Symptoms)
- Definition: Achilles tendinopathy/tendonitis is a condition in which inflammation or degenerative changes develop in the Achilles tendon, causing pain, tenderness, and swelling. The Achilles tendon is the tendon that connects the calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus), and it is involved in weight-bearing and plantar flexion of the foot.
- Causes·pathophysiology: Repetitive overuse (such as excessive running or jumping), improper exercise technique, a sudden increase in exercise volume, biomechanical abnormalities such as flat feet or high arches, and inadequate stretching or muscle imbalance can cause repeated microdamage, resulting in inflammation and degenerative changes in the tendon (fiber deterioration and reduced blood flow).
- Main symptoms:
- Pain in the Achilles tendon area after or during/after exercise (initially occurring mainly immediately after activity)
- Swelling, tenderness, and warmth
- Stiffness immediately after waking in the morning or stiffness when beginning activity
- As the condition progresses, pain may persist even during light activity or at rest, and, rarely, calf cramps or difficulty walking may occur
Treatment Methods
- Conservative treatment (primary standard)
- Activity modification and rest: Limit excessive running and jumping activities until the inflammation improves
- Physical therapy: Stretching and strengthening (particularly an eccentric calf-strengthening program, which is effective); extracorporeal shock wave therapy (ESWT) is used in some cases
- Braces/shoes: Reduce the load on the tendon with a heel pad (2–3 cm high) or custom insoles (orthotics)
- Medication: Control pain and inflammation with nonsteroidal anti-inflammatory drugs (NSAIDs) (short-term use)
- Symptom-relief treatments such as icing and manual therapy
- Interventional treatment (when conservative treatment fails)
- Extracorporeal shock wave therapy (ESWT): Used to improve symptoms in chronic tendinopathy
- Injection treatment: PRP (platelet-rich plasma), prolotherapy, and other treatments are under study, but evidence is limited. Steroid injections into the tendon are generally not recommended because of the risk of tendon rupture.
- Surgical treatment
- If there is no improvement with conservative treatment or structural damage is present (extensive degenerative changes or partial tendon tear), surgery such as tendon decompression, excision of the lesion, and repair may be considered
- Precautions·risk of complications·self-care considerations
- Excessive stretching or high-impact exercise during the acute phase may worsen the condition
- Steroid injections around or into the tendon require caution because of the risk of tendon weakening and rupture
- Appropriate rehabilitation (eccentric strengthening) and a gradual return to exercise are important for preventing recurrence
- Complications: Chronicity, partial or complete tendon rupture, persistent pain, and functional impairment
Checklist Before an Outpatient Visit (Including Items to Bring and Sample Questions)
- Items/medical records to bring
- List of medications currently being taken (including anticoagulants and antithrombotic agents)
- Medical history (especially previous ankle/calf injuries and previous diagnoses or surgeries)
- Copies of previous imaging/test results (ultrasound, MRI, X-ray, etc.), if available
- The time symptoms began, factors that worsen or improve them, and a pain diary (including the type and intensity of exercise)
- Photos of the shoes currently being worn or the actual shoes (especially athletic shoes)
- Information to provide to the doctor during the outpatient visit (examples)
- Location of the pain (midportion of the tendon or insertion site), intensity (quantifiable if possible), and time of onset
- Activities associated with the pain (which exercises or movements worsen it)
- History of previous physical therapy, medication, or procedures and whether they were effective
Examples of General Questions to Ask the Doctor
- What is the exact diagnosis of this condition? (midportion tendinopathy vs. insertional tendinopathy, etc.)
- What initial treatment plan is recommended? How long should conservative treatment be tried?
- What are the side effects of the prescribed medication and the precautions while taking it?
- How should the rehabilitation (exercise) program be carried out, and when can I resume exercise?
- If surgery is needed, under what circumstances would it be performed and what is the expected recovery period?
Examples of Condition-Specific Questions
- In my case (based on the symptom location and exercise pattern), is eccentric strengthening (the Alfredson protocol) appropriate? Specifically, how should I begin?
- Degenerative changes (or a partial tear) were seen in the tendon on ultrasound or MRI. Would it be reasonable to try additional conservative procedures (ESWT, PRP, etc.) before surgery?
(Note: Ultrasound and MRI are commonly used for diagnosis, and evaluation and treatment are provided in the department of orthopedic surgery. Early, appropriate treatment can reduce the risk of chronicity and rupture.)