Achilles tendinitis symptoms start with inflammation of the calcaneal tendon and the surrounding area. The actual site of inflammation may be where the tendon makes a strong attachment to the calcaneus (lower) or at the junction between the lower leg musculature and the Achilles tendon (higher). Over time, Achilles tendinitis (also spelled tendonitis) can become a chronic, degenerative condition referred to as Achilles tendinosis. Rather like other tendinopathies found elsewhere in the body, Achilles tendinosis may become symptomatic at any point along the degenerative timeline. For example, someone may have inflammation of the Achilles tendon that is not yet symptomatic or painful. As this inflammation continues, it is unresolved and degenerates into a chronic, Achilles tendinopathy.
The condition may become symptomatic when the Achilles tendon is asked to do more. This can occur suddenly with a change in footwear, going for long hike, jumping rope, or any loading of the tendon that is different from previous activities. I often refer to this as an acute exacerbation of a previously asymptomatic, chronic, degenerative condition.
In every case of Achilles tendinitis, there is a mechanical inefficiency that sets the stage for inflammation and subsequent pain. Here are some common causes of Achilles tendonitis symptoms:
- Increased tension/shortening of the gastrocnemius and soleus (calf muscle)
- Increased repetitive strain or sudden straining of the Achilles tendon. This can occur when wearing flatter shoes or uphill hiking/running.
- Poor lower leg muscle and Achilles tendon flexibility secondary to aging or training errors.
- Poor foot stability and poor ankle range of motion. This combination is particularly troubling for one’s lower leg muscles.
- Poor lumbar spine stability, which causes overactivity of the lower leg muscles as a compensation to gain control while walking.
To diagnose Achilles tendinitis accurately, one needs to examine the Achilles tendon and the surrounding area. This should also be performed with a functional examination of the foot, knee, and hip with consideration to what biomechanical factors are resulting in overload of the tendon.
Without addressing the initial biomechanical problems of the walking system, one should expect the Achilles tendonitis symptoms to episodically return.
There are other conditions which mimic the Achilles tendinitis symptoms:
- Calcaneal bursitis, commonly induced by trauma or ill fitting shoes.
- Myofascial pain referral. This is actually very common and results from myofascial trigger points referring pain to the heel.
- Sever’s disease, which is an inflammation of the bone growth center on the calcaneus. It causes heel pain in adolescents between 8 and 15 years old.
- Plantar fasciitis, which often shares similar biomechanical factors with heal and achilles pain syndromes.