Achilles Tendinitis

Part 3 

Doctor’s Examination

After you describe your symptoms and discuss your concerns, the doctor will examine your foot and ankle. The doctor will look for these signs:

  • Swelling along the Achilles tendon or at the back of your heel -Bone spurs or pain near the lower part of the tendon at the back of your heel (insertional tendinitis)
  • Pain in the middle of the tendon, (noninsertional tendinitis)
  • Heel pain when stretching your calf
  • Limited range of motion in your ankle — specifically, a decreased ability to point your toes downward

Tests

Your doctor may order imaging tests to help determine if your symptoms are caused by Achilles tendinitis. These tests can also help your doctor ascertain the severity of your Achilles tendinitis.

 X-rays

X-rays provide clear images of bones. They can show bone spurs on the back of the heel, which may be present in patients with insertional Achilles tendinitis. In cases of severe noninsertional Achilles tendinitis, X-rays may show calcification in the middle portion of the tendon.

Magnetic Resonance Imaging (MRI)

Although magnetic resonance imaging (MRI) is not necessary to diagnose Achilles tendinitis, it is important for planning surgery if nonsurgical treatment is not effective. An MRI scan can show the severity of the damage in the tendon. If surgery is needed, your doctor will select the procedure based on the amount of tendon damage.


Ultrasound

Ultrasound has grown in popularity among physicians in recent years. It is quicker and less expensive than MRI and may be readily performed in an office setting. However, ultrasound is more operator-dependent than MRI and may yield less consistent results.

Nonsurgical Treatment

In most cases of Achilles tendinitis, nonsurgical treatment options will provide adequate pain relief, although it may take a few months for symptoms to completely subside. Even with early treatment, the pain may last longer than 3 months.

The mainstays of nonsurgical treatment include anti-inflammatory pain medications, activity modification, shoe wear modification, and physical therapy exercises.


Rest

The first step in reducing pain is to decrease or even stop the activities that make the pain worse. If you regularly participate in high-impact exercises (such as running), switching to low-impact activities will decrease the amount of stress on the Achilles tendon. Cross-training activities such as biking, elliptical exercise, and swimming are low-impact options to help you stay active. Your doctor may recommend an ankle brace or boot immobilization to help with this step.

Ice

Placing ice on the most painful area of the Achilles tendon is helpful and can be done as needed throughout the day. This can be done for up to 20 minutes at a time, but the ice should be removed sooner if the skin becomes numb.

A foam cup filled with water and then frozen creates a simple, reusable ice pack. After the water has frozen in the cup, tear off the rim of the cup. Then rub the ice on the Achilles tendon. With repeated use, a groove that fits the Achilles tendon will appear, creating a custom-fit ice pack. (To be continued)