Achilles tendinitis is an inflammation of the surrounding sheath (paratenonitis), degeneration within the substance of the tendon (tendinosis) or a combination of the two.
The exact causes are not completely understood. There is a correlation with a recent increase in the intensity of an exercise program. It can be associated with repetitive activities which overload the tendon structure, postural problems such as flatfoot or high-arched foot, or footwear. It can also be due to the aging process.
Symptoms typically start gradually and spontaneously. Aching and burning pain is noted to back of the heel, especially with morning activity. It may improve slightly with initial activity, but becomes worse with further activity. It is aggravated by exercise. Over time less exercise is required to cause the pain.
The Achilles tendon is often enlarged, warm and tender to touch.
Most cases are successfully treated non-surgically although this is time-consuming and frustrating for active patients. Treatment is less likely to be successful if symptoms have been present more than six months.
Nonsurgical management includes nonsteroidal anti-inflammatory medications, rest, immobilization, limitation of activity, ice, stretching and heel lifts or custom orthotics.
If all conservative options have been exhausted and there is still heel pain, surgical intervention may be warranted.