Summary
- Presents as pain, swelling, and stiffness in the lower poster leg behind the heel; caused by repetitive tiny injuries, lack of flexibility, over-pronation, recent changes in footwear, and changes in exercise training schedules.
- Common also in patients with ankylosing spondylitis and psoriatic arthritis.
- Can be seen on patients taking medicine from group of fluoroquinolones (e.g. ciprofloxacin, ofloxacin) for long period.
- Genetic predisposition is a risk factor.
Diagnostic tips
- Pain and swelling on the heel area.
- Exclude tear by palpation and Thompson test.
- Most prominent pain in the area about 2-4 cm above where the tendon attaches to the heel.
- Experience the most significant pain after periods of inactivity.
- Limited range of motion in the ankle.
- Thickening or enlargement of the Achilles tendon.
Tests and Imaging
- X-rays could be normal but is essential to evaluate other possible conditions.
- Ultrasound or MRI performed for evaluation of tears within the tendon.
Immediate Treatment
- Crutches and immobilization of ankle for tears.
- May take over 6 months to heal.
- R.I.C.E.R.
- Analgesia
Possible Referral
- Podiatry for immobilisation with cam walker, orthoses, footwear advice, stretching/strengthening program.
- Orthopaedic surgeon for surgical repair..