Achilles Pain

Achilles Pain

My aunty has a heel pain problem, the pain goes where the Achilles tendon attaches to the heel bones, which interfere her normal activities, particularly when she exercises.   What are the possible reasons? Should she see a doctor immediately? 

There are two types of Achilles tendinosis (inflammation of the tendon), based upon which part of the tendon is inflamed- insertional tendinosis and non-insertional. 

Pain occurring in the area where the Achilles tendon attaches to the heel bone is known as insertional Achilles tendinitis involving the lower portion of the tendon. This type of Achilles tendinosis is more common in the middle to older age group. 

In non-insertional Achilles tendinitis, fibers in the middle portion of the tendon have begun to degenerate. Tendinitis of the middle portion of the tendon more commonly affects younger people.

Bone spurs (extra bone growth) often form with insertional Achilles tendinosis as a response to repetitive stress to the tendon. The tendinosis is typically not related to a specific injury and is a chronic degenerative condition. The bone spur (extra bone growth) where the Achilles tendon attaches to the heel bone can rub against the tendon and cause pain.  Some patients experience pain and swelling that is present all the time and it gets worse throughout the day with activity. 

In most cases, nonsurgical treatment options will provide pain relief, although it may take a few months for symptoms to completely subside. A structured physiotherapy program helps to condition and strengthen the Achilles tendon. 

Surgery should be considered to relieve Achilles tendinosis only if the pain does not improve and it becomes difficult to wear shoes or perform simple day to day activities. It is best to discuss the options with your orthopedic specialist. The specific type of surgery depends on the location of the tendinitis, amount of bone spurs and the amount of damage to the tendon. The goal of this operation is to remove any excessive bone spurs and repair the damaged part of the Achilles tendon. There are several techniques ranging from keyhole surgery to mini-open surgery for insertional Achilles tendinosis. 

Prepared by,

Dr K Kannan

MBBS (S’pore), MRCS (Edin), MMed (Orth Surg), FRCS (Edin) (Ortho & Trauma), FAMS (Orthopedics)

Consultant Orthopedic Specialist Surgeon