Achilles Tendon Pain and Pain in the Back of the Heel

The Achilles tendon is one of the largest and most important tendons in the body. The Achilles tendon runs down the back of the lower leg, connecting the calf muscles to the back of the heel. The Achilles tendon is vital for normal walking, function, and activities. Unfortunately, due to a heavy workload, the Achilles tendon can develop pain. It can become diseased with “high mileage” and lack of elasticity causing pain, enlargement, and disability.

Achilles tendonitis is simply inflammation of the Achilles tendon and is usually short-lived and treated with ice, anti-inflammatories, and rest. Achilles tendonosis is chronic overuse and degeneration of the Achilles tendon. The tendon develops microscopic tears, becomes scarred, and loses its elasticity. If degeneration occurs along the tendon itself, this puts patients at a higher risk of Achilles tendon rupture. Most often, degeneration occurs at the attachment to the back of the heel. Over time, the scarred and diseased tendon calcifies at the back of the heel. This is often called Achilles insertional calcinosis or heel spurring.

Symptoms of Achilles tendonitis, tendonosis, and insertional calcinosis/spurring usually include pain (aching, stiffness, soreness) anywhere along the tendon, calf, or back of the heel. Often pain occurs when getting up in the morning or after periods of sitting, then improves after it “loosens up”, but then worsens with prolonged activities. As the disorder progresses, the tendon, (and often the back of the heel), enlarges and may develop nodules. Often the enlargement in the back of the heel can be irritated and can be painful with pressure from shoes.

These disorders are basically “overuse” conditions caused by repetitive activity that puts too much stress on the Achilles tendon. Repeated micro-injury to the tendon fibers and ongoing stress overcomes the body’s ability to repair the injured tendon. Athletes are at high risk for development of Achilles tendon disorders. Individuals that stress their feet/ankles with jobs that require heavy work are also at risk. Overweight individuals commonly develop Achilles tendon pain. “Weekend warriors” also place their Achilles tendons in jeopardy as the tendon is irregularly stressed and generally less conditioned for rigorous stress. People with biomechanical abnormalities, (the way the feet function and the way the patient walks), can greatly contribute to development of Achilles tendon disorders due to greater demand placed on the tendon. Individuals with a “tight heel cord” or contracture/tight/shortened Achilles tendon are also pre-disposed to Achilles tendon pain and other conditions. Incidentally, use of inclined treadmills or walking/running on hills can contribute to Achilles tendon pain.

Achilles tendonitis, tendonosis, and calcinosis/spurring are diagnosed with clinical examination, x-rays, ultrasound, and/or MRI. Treatment for these conditions is selected based on the severity of pain/disability, age and activity of the patient, and degree of degeneration of the tendon. When caught early treatment is relatively simple and can prevent the Achilles tendon from further degeneration and disease. Unfortunately, advanced tendon disease is more difficult to treat conservatively and often leads to chronic and repeated episodes of pain and ongoing treatments or the need for a surgical procedure. Conservative treatments include anti-inflammatories, icing, rest, immobilization, topical medications, stretching, shoe inserts/heel lifts, physical therapy, and injection therapy. The latest treatments include musculoskeletal laser treatments, (MLS Laser Treatment), EPAT/”shockwave” treatments, amniotic injections, and PRP injections which have all shown excellent improvements and results. MLS Laser Treatments are painless, quick, and noninvasive and performed in the office with no anesthesia. When these modalities fail, surgical techniques are successful to eliminate pain and repair the tendon in an outpatient setting.

Prevention is the key to reducing degeneration of the Achilles tendon. Evaluation for biomechanical abnormalities, (treated with orthotics or proper shoes), stretching, and proper conditioning can all help prevent long-term Achilles tendon problems. If you have pain in the back of your heel or Achilles tendon, get evaluated today.

Houston Foot and Ankle
Locations in Kingwood, Spring, Houston, Atascocita, and Mont Belvieu
Jason C. Miller, DPM, FACFAS, FASPS
Daren M. Guertin DPM, FACFAS
Jacob Hord, DPM, FACFAS
Laura Woodcox, DPM
Elizabeth Fernandez-Arias, DPM
Laura Richards, DPM
Adam Long, DPM