Achilles tendon pain
introduction
Pain in the Achilles tendon is very common, and not only in those who exercise regularly. The pain can have many different causes. In general, Achillodynia and inflammation, which are usually an expression of overloading of the Achilles tendon, can be attributed to pain as a result of injuries in the area of the Achilles tendon, e.g. Achilles tendon tears, demarcate. A third disease that can trigger Achilles tendon pain is heel spur.
Read more on the topic: What is pain
Causes of Achilles tendon pain
If Achilles tendon pain occurs, it is usually due to an inflammation in the Achilles tendon. This inflammation, too Achillodynia called, arises, especially with athletes, very often due to an overload. In running and jumping sports, the Achilles tendon is stressed many times more than when walking or standing. This can cause micro-cracks that cause an inflammatory reaction. This is accompanied by pain in the Achilles tendon. Repeated excessive stress can damage the tendon so severely that it is less resilient. This can cause the Achilles tendon to tear.
The tendons in the human body are located in so-called tendon sheaths, which by secreting fluid guarantee that the tendons glide smoothly during movements and nourish them. The metabolism of tendons is not very active, so injuries only heal very slowly. Overloading and injuries to the Achilles tendon during sport can be prevented by gently warming up. Then the tendon sheaths have time to build up more fluid, which means that the Achilles tendon glides better when moving. Achilles tendon pain can also be triggered by rheumatic diseases. This creates an inflammation in which the own immune system is directed against the tissue of the tendon sheaths. A common rheumatic disease associated with Achilles tendon pain is ankylosing spondylitis.
Appointment with an expert in Achilles tendonitis?
I would be happy to advise you!
Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".
But now enough is indicated ;-)
Athletes (joggers, soccer players, etc.) are particularly often affected by the Achilles tendonitis disease. In many cases, the cause of the Achilles tendonitis cannot be identified at first. Therefore, the treatment requires a lot of experience. I focus on Achilles tendonitis.
The aim of every treatment is treatment without surgery with a complete recovery of performance.
Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.
You can find me in:
- Lumedis - your orthopedic surgeon
Kaiserstrasse 14
60311 Frankfurt am Main
Directly to the online appointment arrangement
Unfortunately, it is currently only possible to make an appointment with private health insurers. I hope for your understanding!
Further information about myself can be found at Dr. Nicolas Gumpert
Accompanying symptoms with Achilles tendon pain
Additional symptoms can occur with Achilles tendon pain. The Achilles tendon can thicken in its entire length or only in places. If the pain is due to an upper heel spur, there may be a thickening at the tendon insertion just above the heel. If the tendon is already torn, completely or partially, it may be palpable thinner (partial tear) or a gap has to be felt instead of the Achilles tendon, this is an indication of a complete tear of the Achilles tendon. In this case, it is no longer possible to stretch the foot against force. If the pain in the Achilles tendon is due to a rheumatic disease, there may be numerous other accompanying symptoms that are also triggered by the rheumatic disease. These are often joint swelling, back pain and back and joint stiffness, especially in the morning hours.
What does it mean when the tendon becomes thick or has lumps?
In the course of the inflammatory reaction, the Achilles tendon can thicken, which can then be felt as a lump. In acute inflammation, the Achilles tendon is then tender on pressure. There may also be redness and swelling around the tendon. In this case, it is important to rest until the symptoms have disappeared again and pain-free stress is possible. Recurring inflammation can lead to chronic thickening of the tendon, which is usually not or only slightly painful.
Why does the Achilles tendon hurt especially in the morning after getting up?
Achilles tendon pain often occurs, especially in the morning after getting up. In the case of pain due to inflammation, the reason for this is that little fluid is produced in the tendon sheath at night. Since there is little movement at night, it is not necessary for the body to use energy for this. The inflammation leads to adhesions in the tissue. If you take the first steps in the morning after getting up, new fluid must first be formed so that the tendon can slide well. The first movements loosen the bonds. This is initially accompanied by pain, which typically disappears after a while in motion.
If the pain in the Achilles tendon is due to a rheumatic disease, it is also typical that pain occurs, especially in the second half of the night and in the morning. This is due to the fact that rheumatic diseases are very active, especially during this time. If a rheumatic disease is present, in addition to Achilles tendon pain, joint stiffness in other parts of the body, joint swelling or back pain often occur. The time in the morning until the pain is less again, at around an hour, is also significantly longer than with a normal inflammation.
Achilles tendon pain when jogging
Achilles tendon pain is often noticed for the first time while jogging. This is because the Achilles tendon is exposed to much higher stresses when jogging than when walking. If, for example, it is attacked by repeated overloading, pain occurs first with high stress. If the damage to the tendon continues, the pain can also occur with light loads. If you experience pain in the Achilles tendon while jogging, you should take a break and rest until pain-free exercise is possible again.
Achillodynia
Achillodynia is a common cause of pain in the Achilles tendon, especially in young athletic patients. In general, achillodynias are divided into primary achillodynias, in which there is no explicit risk factor for the occurrence of Achilles tendon pain and the cause is therefore unknown, and secondary achillodynias, in which there are anatomical conditions in particular that cause increased stress on the Achilles tendon and thus pain in the Achilles tendon can trigger. Achillodynia can be differentiated from Achilles tendonitis by the lack of inflammatory cells in the tendon itself. Accordingly, both inflammation of the tendon sheath (not the tendon itself!) And degenerative changes in the tendon can be counted under the generic term “achillodynia”.
Achillodynia are initially noticeable in the form of so-called starting pain. This means that at the beginning of the stressful movement, local pain occurs which is limited to the Achilles tendon and which disappears as the stress progresses. In addition, pain on pressure in the Achilles tendon can often be generated in the early stages. In a more advanced state, pain at rest and swelling on exertion can finally occur.
When diagnosing achillodynia as the cause of pain in the area of the Achilles tendon, a detailed anamnesis is required, i.e. the discussion of possible causes, in the foreground. Important questions are whether the pain occurs at certain times or in connection with certain movements and whether a sport is practiced intensely that could promote the development of pain (e.g. running, ball sports).
Achilles tendonitis
A Achilles tendonitis differs from achillodynia in the presence of inflammatory cells in the tendon itself. However, it can also be the result of achillodynia, for example if the degenerative changes cause an inflammatory reaction or if an inflammation spreads from the tendon sheath to the tendon. Achilles tendonitis is also more common in competitive athletes, especially runners.
Achilles tendonitis manifests itself through the typical signs of inflammation: Pain, redness, swelling, overheating and functional impairment. The time course of the occurrence of the complaints is characteristic: they are above all at the beginning and at the end of a load particularly strong, so relief occurs during exercise. If it is an acute form, the symptoms appear over a period of a few days, usually triggered by a sudden increase in the load (e.g. intensification of training). In the chronic form of Achilles tendonitis, the symptoms persist for a longer period of time, largely regardless of the intensity of the stress. But climbing stairs or uphill in particular are often experienced as particularly painful.
They are also typical of inflammation of the Achilles tendon severe discomfort in the morning after getting up. The reason for this is that the tendon "stiffened". Also in some cases small nodules in the area a few centimeters above the heel tip feel. Occasionally, when moving in the Ankle joint a crunch be heard in the area of the Achilles tendon, which is called "Crepitation mark" referred to as.
Achilles tendon tear
Although the Achilles tendon is the strongest tendon in the human body represents it can too spontaneous cracks the tendon come. In almost all cases, the tendon breaks in the frame high athletic stress, which is why young, sporty patients are particularly affected. The reason for this is that the strong and regular load causes the smallest injuries in the structure of the tendon, which can cause the tendon to tear in the event of an unfortunate sequence of movements. However, a rupture can also occur in inactive patients: Due to the "sport abstinence", the tendon is not used to stress and is therefore more at risk of rupture in everyday life than the "hardened" tendons of athletes when falling stairs or the like.
Other risk factors are age-related degenerative changes the tendon structure and the use of certain medications, such as more diverse Antibiotics or Cortisone.
An Achilles tendon tear can usually be clearly distinguished from the other possible causes of pain in the area of the Achilles tendon, since at the moment of the tear it often appears whip-like bang can be heard. Immediately bet on it severe stabbing pain a. It is characteristic that the patient is no longer able to stand on the toes or even walk with the affected leg. The reason for this is that the Achilles tendon is there to provide the power of Calf muscles (which is responsible for the extension of the foot towards the sole of the foot) on the foot transferred to. If the tendon is now torn, this transfer can no longer take place and the foot can no longer be stretched towards the sole of the foot, as is necessary for standing or walking on the toes. The externally visible symptoms of a ruptured Achilles tendon are one swelling and possibly a bruise in the affected area. In addition, there can often be a Dent can be felt.
Please also read our topic on this 'Achilles tendon tear'
Diagnosing a ruptured Achilles tendon is based on the symptoms above. As positive Thompson test This is the term used to describe the phenomenon when the patient lying on his stomach and squeezing the calf muscles can no longer achieve a stretching movement of the foot towards the sole of the foot - analogous to the no longer possible to stand and walk (see above). In addition to the clinical inspection, apparatus-based procedures can be used, above all the Ultrasound examination, but also that MRI. They can confirm the diagnosis and also clearly show the extent and type of injury, which is relevant for the subsequent decision to be made between the available therapy options.
Please also read our topic on this 'MRI of the Achilles tendon'
Heel spur
A heel spur is a bony outgrowth in the area of the heel bone. The is important for pain in the Achilles tendon upper calcaneal spur, an extension in the area of the insertion of the Achilles tendon. It mainly affects people between 40 and 60 years of age. The cause lies in one increased stress on the Achilles tendon attachmentwhich in turn can have different reasons: These include Age, overweight, foot malformations and poor footwear. Over time, a heel spur can also trigger Achilles tendonitis.
Typical of the heel spur is a shooting pain from movement and pressure at the Achilles tendon attachmentwhich occurs mainly during exercise and is particularly pronounced after longer breaks. Occasionally, the pain is described as burning. A differentiation from the other possible causes of pain in the Achilles tendon is best achieved by the fact that the pain in the heel spur can often be localized precisely to a relatively small area.
A detailed discussion of the type and location of the symptoms as well as the risk factors (see above) suggests a heel spur. The suspicion can then be confirmed with the help of a X-raybecause the heel spur is a bony structure. If the x-ray does not give a clear diagnosis despite symptoms that strongly suggest a heel spur, another can be done MRI examination carried out, with which early stages of a calcaneal spur can also be detected.
Duration of Achilles tendon pain
Since the Achilles tendon is not supplied by blood vessels, but only by diffusion of the tissue and tendon sheath fluid, the metabolism is slow. As a result, it takes a long time for injuries to the Achilles tendon to heal. If the Achilles tendon becomes inflamed due to overload, you should take care of yourself. It usually takes four to six weeks for the inflammation to subside. During this period, painful stress should be avoided so that the tissue can regenerate well. In the case of more serious diseases such as a rupture or partial rupture, the healing process takes longer, usually around 3 months.
Treatment for Achilles tendon pain
If pain occurs in the Achilles tendon, patients can initially relieve the symptoms with home remedies. Because the pain is caused by inflammation, use cooling and anti-inflammatory ointments. Sports activities that strain the Achilles tendon and are painful, such as jogging, should be avoided.
Anti-inflammatory medication can also bring relief, but should be done under medical supervision. With Achilles tendon pain, extracorporeal shock wave therapy can also bring healing success. Cortisone injections should be used cautiously in the case of pain in the Achilles tendon, as they can damage the tendon and are also associated with a risk of infection. It should also be clarified whether there are comorbidities such as a rheumatic disease that are triggering the pain. Often there is pain in the Achilles tendon because of a foot misalignment like that Overpronation present. The foot bends too much inward when rolling, which increases the load on the Achilles tendon. If there is such a misalignment, insoles can often provide a remedy. If the course is severe, an operation to remove damaged tendon tissue may be necessary.
Voltaren
Voltaren preparations contain the active ingredient diclofenac. They can be used as tablets or topically as an ointment for pain in the Achilles tendon. The active ingredient diclofenac is an anti-inflammatory pain medication, similar to ibuprofen. The effect unfolds locally through the inhibition of an enzyme, the cyclooxygenase, which triggers and maintains an inflammatory reaction and the pain associated with it. The use with tablets brings a higher concentration of the active ingredient into the tissue, so that a better effect can be achieved. However, the side effects are also more pronounced. With Voltaren, this is often an inflammation of the lining of the stomach, which leads to stomach pain and which can cause ulcers and bleeding. Therapy with the ointment has fewer side effects, but care must be taken that there are no local skin reactions or allergies.
Taping
Taping can help relieve pain in the Achilles tendon. Stabilizing tape bandages made of firm tape can relieve the Achilles tendon and thus lead to a reduction in symptoms. Tapes such as Leukotape can be used for such bandages. They should be attached by qualified personnel, physiotherapists or doctors. Taping with kinesiotape has a less stabilizing effect. Kinesiotape is said to improve the lymphatic drainage by stimulating the tissue and stimulate healing. Kinesio taping can be helpful for pain in the Achilles tendon, but there is no scientific evidence on its effect.
Which ointments can help?
There are numerous ointments for topical use for Achilles tendon pain. Ointments with anti-inflammatory drugs such as ibuprofen and diclofenac can reduce the inflammation by acting locally. The problem with all ointments compared to medication with tablets is that a large part of the active ingredient does not reach the site of inflammation, but is already absorbed by the skin when it is drawn into the skin. In addition to chemical agents, there are also numerous plant-based ointments that can reduce pain and inflammation. They often also have a warming or cooling component that provides relief. Examples include arnica or horse ointment, tea tree oil and tiger balm.
Home remedies for pain in the Achilles tendon
Home remedies can be helpful for Achilles tendon pain and reduce the pain. The use of cold, quark compresses or cooling ointments is perceived as pleasant, especially with acute inflammation. In chronic pain, the use of heat can improve blood flow to the tendon sheaths and thus reduce pain when moving.
How is the diagnosis of the cause of Achilles tendon pain made?
In order to be able to treat the pain in the Achilles tendon, it is important to make the most accurate diagnosis possible. A detailed questioning by the doctor is important for this. Among other things, it is relevant to know under which stress the pain occurs, where exactly it is localized and whether other symptoms are present. The anamnesis is followed by a physical examination in which the tendon is felt and functional tests can trigger possible painful movements and stresses. In addition to the palpable findings, an ultrasound examination can provide more precise information about the condition of the Achilles tendon. If more precise imaging is necessary, an MRI is used, in which the course of the tendon can be precisely assessed and possible inflammation can be made visible. Further examinations of the position of the feet and, if necessary, blood tests complete the diagnosis of Achilles tendon pain.
MRI of the Achilles tendon
An MRI scan of the Achilles tendon is particularly recommended for chronic pain in the Achilles tendon. With the help of an MRI, inflammation can be detected. The condition of the tendon can also be assessed. This may be necessary to decide whether surgery is necessary.
If a tear or partial tear of the Achilles tendon is suspected, MRI imaging can provide an accurate diagnosis when clinical tests do not provide a clear diagnosis.
You can find a lot more information under our topic: MRI of the Achilles tendon
