Adrianne was excited to improve her performance as her track season got underway. She increased the number and length of her workouts drastically each week and began to notice a gradual increase in discomfort along her Achilles tendon. This seemed to be improved when she would wear a wedge sandal but became almost debilitating when she wore her flat running shoes. By the time she presented to the pediatric orthopedic sports medicine office her ability to compete was markedly affected.

What is Achilles tendonitis?

Achilles tendonitis is an overuse injury to the Achilles tendon in the lower leg. It is the largest tendon in the human body, connecting the calf muscles to the heel bone (calcaneus).

Is Achilles tendonitis common?

Achilles tendonitis is common in teenagers and adults, but not as common in younger kids who have more pain in the heel (calcaneal apophysitis).

What causes Achilles tendonitis?

Achilles tendonitis is inflammation in the Achilles tendon. It occurs when a person does a lot of running or jumping, especially if there is a sudden increase in the amount or intensity.   Other risk factors for Achilles tendonitis include poor flexibility in the legs or other structural differences in the foot. As the symptoms become more chronic, there can be changes to the structure and flexibility of the tendon.

What are the symptoms of Achilles tendonitis?

Symptoms of Achilles tendonitis include pain in the tendon, especially while walking, running or jumping. Patients can have stiffness and even swelling in the area that worsens with activity. Even with short periods of rest, the pain along the tendon may seem more noticeable as the child begins to move around. The pain is localized to the thick tendon above the heel bone and is not in the bony structure of the calcaneus. 

How is Achilles tendonitis diagnosed?

Diagnosis of Achilles tendonitis is made by careful history and thorough physical exam. Sometimes an X-ray is done to insure that the bony structure of the ankle is normal. The Achilles tendon itself is not well evaluated on X-rays. MRI is rarely indicated to evaluate the tendon.

How is Achilles tendonitis treated?

Treatment is conservative, including rest from aggravating activities, ice and pain control. Initially, non-steroidal anti-inflammatory medicines (NSAIDS) are helpful to treat both the pain and inflammation. However, NSAIDS are not helpful in chronic cases of tendonopathy. Stretching and strengthening exercises of the leg muscles using a home exercise program or physical therapy are crucial. Steroid injections while helpful in other tendon related problems are not used in Achilles tendonitis. Surgery is almost never indicated. When the patient is ready to return to activity, it is important to gradually increase amount and intensity to prevent relapse.

What is the long term outlook for my child with Achilles tendonitis?

Most teens with Achilles tendonitis do well and recover without long lasting problems. However, it can become a chronic and difficult condition, especially in adults or in patients who don’t follow guidelines to allow healing.

Adrianne was diagnosed with Achilles tendonitis. Because she was so determined to return to her sport she followed the rehab and healing program to the letter. She was instructed to use anti-inflammatory medications, ice, rest, and stretching over the next two weeks.   When her symptoms had resolved adequately, she worked with her coach and athletic trainer to design a progressive return to her running activities.