Dealing with chronic Achilles pain
Chronic Achilles pain can be disruptive to daily life to the point of debilitation. In this article, a consultant orthopaedic surgeon discusses the possible causes of chronic Achilles pain and how they can be addressed.
The Achilles tendon, the strongest in the body, connects the calf muscles to the heel bone, enabling us to walk, run, dance, and jump, amongst a plenitude of other actions with our feet. When this tendon becomes inflamed or injured, it is likely to become sensitive and painful. This obstructs patients from participating in their daily tasks and activities to the point of even altering gait.
What causes chronic Achilles pain?
There are several reasons why the Achilles tendon may be painful for an extended period of time, most likely occurring due to overuse of the tendon. Common ailments include:
- Tendonitis. Common in athletes. The tendon swells and stiffens.
- Paratenonitis. Inflammation of the sheath around the tendon. The ankle swells and may be accompanied by a ‘popping’ sensation when in use.
- Rupture. The tendon tears or detaches, often from sudden, forceful impact. Very severe and only surgically treatable.
If patients fail to treat their Achilles when it begins to become uncomfortable, these issues can worsen and contribute to long periods of constant pain.
Other contributing factors to Achilles tendon pain may include ill-fitting footwear, tight muscles, abnormal gait and posture, and unusual foot anatomy.
Getting medical care for a dysfunctional Achilles tendon is important, as leaving the pain unaddressed can progress to rupture.
How is chronic Achilles pain diagnosed?
To diagnose the root cause of chronic Achilles pain, doctors will begin their investigation with a physical exam and patient history, asking the patient about their habits, the severity of their pain and how it incapacitates them. Following that, they will employ imaging scans like MRI or ultrasound to assess the physical structure of the tendon and surrounding tissue in the ankle.
Once a diagnosis is confirmed, the doctor is able to devise a treatment plan for the patient.
How is chronic Achilles pain treated?
In the case of injury from overuse, the standard course of action is nonsurgical, which will prioritise rest, rehabilitation, and low-impact activity. Orthotics, which are shoe inserts specialised to improve gait and stance as well as reduce strain on the tendon, may be ordered. Patients can consider painkillers and anti-inflammatory medication to help with the pain and swelling. Physical rehabilitation will help strengthen and stretch the muscles around the ankle to better support the tendon.
Patients needing further intervention for the pain may be suitable for corticosteroid injections, which will also reduce inflammation, but this is not a cure as overuse can weaken the tendon.
More intensive therapies include shockwave therapy, which will promote blood flow and stimulate stem cell activity to kickstart healing.
Should conservative treatment fail, then surgery might be suggested. Surgery could involve debridement, where damaged or loose tissue is cut away or repair, where two torn ends of the tendon are resecured.