The Achilles tendon is the largest tendon in the human body and also the most powerful. Pain at the back of the heel is associated with Achilles tendinitis, which is inflammation of the Achilles tendon as it runs behind the ankle and inserts on the back surface of the heel bone. It is common among people who run and walk a lot and have tight tendons. Anyone can suffer from Achilles tendinitis but it typically affects middle aged people who engage in activities involving running.
The condition occurs when the tendon is strained over time, causing the fibers to tear or stretch along its length, or at its insertion on to the heel bone. This leads to inflammation, pain, and the possible growth of a bone spur on the back of the heel bone. The inflammation is aggravated by the chronic irritation that sometimes accompanies an active lifestyle and certain activities that strain an already tight tendon.
Anyone can suffer from Achilles tendonitis but it typically affects middle aged people who engage in ballistic activities. Children may also develop symptoms of Achilles tendinitis but their symptoms are typically less severe. Men ages 30-50 are at high risk of rupturing their Achilles tendon. People with flat feet cause more strain to their achilles tendon thus resulting in a higher prevalence of tendinitis. Bad or improper shoe gear can lead to increased strain on the tendon thereby leading to tendinitis. People who are obese, have high blood pressure, or are diabetic all have increased chance of developing tendonitis. Also, certain drugs such as fluoroquinolones have been documented to cause Achilles tendonitis and spontaneous rupture of the tendon.
Initially the pain may present itself as a mild ache above the heel bone. The pain can become worse with activities such as running and jumping. The pain can become severe with prolonged physical activities. After periods of rest there may be stiffness to the ankle joint especially first thing in the morning.
The podiatrist will examine the area and may request diagnostic X-rays or an ultrasound to rule out problems of the bone or tearing.
Early treatment might involve oral anti-inflammatory medication, exercise and shoe recommendations, taping or strapping, or the use of shoe inserts or orthotic devices. Taping or strapping supports the foot, placing stressed muscles and tendons in a physiologically restful state. Physiotherapy may be used in conjunction with such treatments.
A functional orthotic device may be prescribed for correcting biomechanical imbalance, controlling excessive pronation, and supporting the ligaments and tendons attaching to the heel bone. It will effectively treat the majority of heel and arch pain without the need for surgery.
Only a relatively few cases of heel pain require more advanced treatments or surgery. Surgical treatment is only considered after all conservative therapies fail or a rupture occurs. Open repair of the achilles tendon is an option if a rupture is diagnosed and is deemed repairable. A MRI can help to confirm the extent of damage to the Achilles tendon. Any surgical treatment of the Achilles will require a lengthy recovery period due to the high possibility of re-rupture.
A variety of steps can be taken to avoid achilles pain and accompanying afflictions:
When to Visit a Podiatrist
If pain and other symptoms of inflammation—redness, swelling, heat—persist, limit normal daily activities and contact one of the podiatrists at the footinjuryclinic.