The Achilles tendon may be the Rodney Dangerfield of the body – it gets no respect. This is the largest and strongest tendon in the body. It is the only tendon where the fibers rotate like a cable creating a dramatic increase in strength. It takes a lot of repetitive force to cause problems in this area. Even though Achilles tendonitis typically is a result of a long term cause it may appear with a sudden onset of symptoms like a slow leak in a tire that eventually goes flat.
Symptoms of Achilles Tendinitis
Symptoms from Achilles tendinitis can appear from just above the heel to below the heart-shaped calf muscle. You will experience tenderness when you first start walking after sitting for a while, especially after sleeping. Look for an area of tenderness when you run your fingers down both sides of the tendon and search for an area of tenderness the width of your index finger. If there is no change in size the Achilles tendon - that is a good sign. If you notice isolated swelling, a distinct deficit or small depression you have a significant problems. If that defect is large, you may have a critical problem with a tendon tear.
To help a tendon to glide freely, there is a sheath around the tendon that provides lubrication. If you find a long extended area of tenderness when you run your finger down the tendon, this sheath may also be inflamed. It may even feel spongey or “crunchy” with movement or pressure. This is a sign of chronic irritation and is a significant problem.
Any area of the Achilles tendon is a NO injection zone. There is also a potential problem with certain antibiotic in the quinolone family that is linked to spontaneous tendon ruptures. It does not happen with every use but is something to be aware of for up to one year after using this medication. In an extreme case, I have treated tendon damage that was noticed after one week of using a nasal spray with this medicine.
If there is tenderness in the muscle or in the junction between the muscle and tendon, this is a muscle injury and should respond to rest in 2 – 4 days. This is typically from an increase in activity such as starting a new exercise program, long activity with a flat shoe than you are not accustomed to, or long walks on the beach.
When treating this problem in active people, we consider rest a dirty word. Our goals are to maintained activity and improve comfort if treated in the early stage. To be realistic, if you have Achilles pain more than one month, this may not be in your treatment options. Soft tissue inflammation is like a forest fire: the sooner it is identified, the easier it is to resolve with minimal damage.