The Achilles tendon goes from the calf muscle down to the back of the heel, and helps with moving the ankle in a downward direction, as would occur with standing on your toes.
As seen in this diagram, the tendon attaches to the back of the heel bone (calcaneus) about halfway between the top and bottom of the back of the heel bone. This region can degenerate or have some rubbing on bone spurs that form on the back of the heel (see X-ray below)
The suffix "itis" refers to inflammation, so Achilles tendonitis is a condition where at the insertion of the Achilles tendon on the back of the heel, there is inflammation, usually due to partial tearing of this part of the tendon.
The X-ray here shows an example of a bony prominence on the posterior aspect (back side) of the heel where the bone spurs rub the tendon. This rubbing can cause partial tearing of the tendon, and inflammation of the bursa, which is the lubricating sac, between the tendon and the bone. This prominence is called a Haglund deformity.
In the xray shown for this patient, due to chronic inflammation at the region where the Achilles attaches to the bone, the patient has developed bone spurs.
Another bone spur has developed on the sole of the foot where the plantar fascia attaches (for more info on plantar fasciitis, click here.)
In the MRI of this patient, you can see the Achilles tendon, which higher up in the leg, above the heel bone, looks black.
The region just near where the tendon attaches, where the partial tearing occurs, looks more white on the MRI since there is more water content in the tissues due to the inflammation occurring. Also, the inflammation of the bursa (bursitis) can be seen.
This particular patient happened to have a later misstep and pulled off the attachment of the Achilles, along with the bone spur, and required surgical treatment for reattachment of the tendon.
Sometimes, as part of the repair procedure, the tendon is too tight and needs to be lengthened with a procedure called a V-Y lengthening.
Treatment (non-operative)
Stretching program (for more info, see the page on plantar fasciitis, since the stretching program for that condition also works for Achilles tendonitis)
Anti inflammatory medicines
(Ibuprofen/Advil, Naprosyn/Aleve, Relafen, Lodine, Voltaren, Celebrex, Mobic, etc.)
Walker boot can help with acute pain, to allow the patient to both walk and rest the tendon at the same time. However, more important than the boot, is participation in a stretching program, as shown above.
…but it can take between 6 weeks and 6 months for symptoms to resolve completely.
When operative treatment is chosen, the decision is made by the patient, as they will at some point feel that no progress is being made, and they might decide to undergo surgical treatment.
