There are a variety of disorders of the Achilles tendon. It is important to understand the differences between them.
A sudden onset of pain in the back of the ankle ("it felt like someone kicked me in the ankle" is the usual report), accompanied by swelling and weakness, is most likely an Achilles tendon rupture. This happens as the tendon silently degenerates and then undergoes a sudden stressful event like pushing off to run or stepping down and backwards. The sudden pull of the calf muscle (gastrocnemius), the strongest muscle in relation to its size in the body, causes the weak and degenerated tendon to rip apart. Most ruptures are complete.
Rapid treatment within 3 days allows patients the choice of all the options (surgical and nonsurgical). Most ruptures occur in middle-aged men. If you feel you have a ruptured Achilles, call our office right away to get an appointment as soon as possible.
Some patients develop painful swelling in the back of the heel. This area causes pain in one of two ways: from rubbing on the shoe or from rubbing the Achilles on the inside of the heel bone itself. It's easy to tell which one is the cause. Take off your shoes and if it still hurts when you walk, the problem is clearly deeper.
The pain and tearing is caused as the Achilles wraps over the back of a sharp edge of a square heel bone. The pain is worst with the first few steps and then may improve a little. Often it worsens over the course of the day. It may feel warm and swollen. People often curtail their activities in an attempt to accommodate or live with the pain.
Eventually, the accommodation leads to secondary problems (calf muscle contracture, lateral ankle instability, even 2nd toe troubles, to name a few). When allowed to fester, these problems will complicate the treatment required for best results.
Treatment for the pain from rubbing on the back of the heel (Pump Bump Syndrome) starts with correcting the shoes so they do not cause friction. Treatment for the deeper problems is more difficult. Stretching the calf muscle with a runner's stretch or off the back of a stair for 6 weeks may help. Anti-inflammatory medications like naprosyn or ibuprofen can provide some symptom control. Wearing a small heel wedge, heel lift, or low-heeled shoes allows the Achilles to rest. The eccentric strengthening exercise of slowly letting your heel down from a tip-toes position is the most helpful and proven exercise. If you still have pain after 6 weeks, it's not likely to go away with these techniques. Please come and see us, as we can give you some other options. Recovery time from surgical options varies, as new and exciting technologies have become available.
For a thorough review of Insertional Achilles tendon disorders please see the following link: http://www.footeducation.com/posterior-heel-pain
Pain in the back of the ankle directly on the Achilles tendon (the hard thick cord just beneath the skin), makes walking and exercise difficult. With non-insertional Achilles tendonopathy (tendon problems) the area becomes swollen, tender and may eventually become nodular. Advanced degeneration of the tendon causes gradual lengthening or a slow rupture, which results in significant strength losses. Initial treatment is similar to that of insertional Achilles disorders and includes using a heel lift, calf muscle stretching, eccentric strengthening (heel drops) and anti-inflammatory medication. Often patients choose accommodation before seeing us, and the typical secondary problems develop.
If you still have pain after 6 weeks, it's not likely to go away with the above techniques. Please come and see us so we can give you some other options. Recovery time from surgical options varies, as new and exciting technologies have become available. More recently, percutaneous injections through the skin of PRP (platelet rich plasma) has shown efficacy and poses little risk and very rapid recovery. Even if this isn't a possibility, there is always a way to make this pain better.
For a thorough review of the condition see: http://www.footeducation.com/achilles-tendonitis