what causes achilles tendonitis in both feet?

An Achilles tendon injury is a risk for anyone, regardless of whether they’re an athlete or simply going about their daily activities.

The Achilles tendon, the body’s largest tendon, extends from the heel bones to the calf muscles. It is identifiable as a resilient band of tissue located at the back of the ankle and above the heel. This tendon enables downward toe pointing and tiptoeing due to its robust, elastic fibers, capable of withstanding pressures of up to 1,100 pounds.

However, due to limited blood circulation in this area, the Achilles tendon is susceptible to injury, often referred to as tendinitis or tendonitis by medical professionals. Symptoms may include sensations of burning or stiffness in the lower leg. In severe cases, the Achilles tendon may suffer partial or complete tears, causing intense pain.

Achilles Tendon Injury Symptoms

Here are some typical indicators of an Achilles tendon injury:

1. Stiffness and tightness in the Achilles tendon upon waking in the morning.
2. Discomfort or pain along the length of the Achilles tendon.
3. Experiencing increased pain during physical activity.
4. Feeling heel discomfort while wearing shoes.
5. Experiencing heightened pain the day after engaging in physical activities.
6. Noticeable thickening of the tendon.
7. Presence of bone spurs, which are bony growths.
8. Persistent or recurring swelling in the affected area.
9. Specific pain localized in the Achilles tendon.

The most apparent indication of an Achilles tendon injury is experiencing pain above the heel, particularly when stretching the ankle or standing on tiptoes. Initially, the pain might be mild and fluctuate in intensity over time. However, in cases of tendon tears or ruptures, the pain emerges suddenly and can be intense. Seeking medical attention promptly is advisable in such instances.

Formation of a lump on the Achilles tendon is a common occurrence following an injury. This lump may result from swelling and can signify moderate Achilles tendinitis. Alternatively, if the lump persists for an extended period, it could indicate the ongoing healing process in the area.

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Types of Achilles Tendon Injuries

There are two primary types of tendinitis affecting distinct sections of the Achilles tendon:

1. Noninsertional Achilles tendinitis: This type involves the breakdown, swelling, and thickening of fibers within the middle portion of the tendon. It is more prevalent among highly active individuals, particularly runners.
2. Insertional Achilles tendinitis: This condition affects the lower segment of the heel, where the tendon inserts or attaches to the heel bone. It often leads to the development of bone spurs. While insertional Achilles tendinitis is common in runners, it can occur in individuals regardless of their activity level. Tight calf muscles are a frequent contributing factor, increasing stress on the Achilles tendon.

Individuals may experience one or both types of tendinitis simultaneously.

Other Achilles tendon-related injuries include:

• Achilles bursitis: Found at the back of the heel, a fluid-filled sac known as a bursa cushions the Achilles tendon as it moves over the heel bone. Overuse, health conditions like arthritis or gout, or wearing tight shoes that rub against the heel can irritate and inflame this bursa, leading to Achilles bursitis, also termed retrocalcaneal bursitis.
• Achilles tendon rupture: A tear in the Achilles tendon, causing a snapping or popping sound upon occurrence. This is distinct from tendinitis. Rupture symptoms include immediate and intense pain, along with bruising, swelling, and difficulty pointing or pushing off the toes when walking.

Achilles tendinitis vs. tendinosis:

• Achilles tendonitis or tendinitis denotes inflammation of the tendons, typically a short-term condition.
• Achilles tendinosis refers to persistent or long-term tendinitis, where tendon cells begin to deteriorate, potentially affecting the functionality of the Achilles tendon.

Achilles Tendon Injury Causes

Achilles tendon injuries frequently occur during activities involving rapid acceleration, deceleration, or pivoting, including:

• Running
• Gymnastics
• Dance
• Football
• Soccer
• Baseball
• Softball
• Basketball
• Tennis
• Volleyball

These injuries typically occur during sudden movements when initiating propulsion and lifting the foot, rather than during landing. For example, a sprinter may sustain an injury at the beginning of a race when surging off the starting block, overwhelming the tendon’s capacity to withstand the force.

Repetitive stress injuries can also result from continually subjecting the Achilles tendon to high-impact activities.

However, you need not be an athlete to experience such injuries. Traumatic incidents like stepping into a hole or falling from a height can also lead to Achilles tendon ruptures.

Achilles Tendon Injury Risks

Several factors increase the likelihood of experiencing an Achilles tendon injury:

• Wearing high heels, which can exert stress on the tendon.
• Having “flat feet” or fallen arches, wherein the arch of the foot collapses upon impact during a step, causing stretching of muscles and tendons.
• Tightness in leg muscles or tendons.
• Presence of bone spurs.
• Increasing the duration or intensity of exercise routines.
• Initiating a new type of exercise.
• Wearing ill-fitting shoes or footwear unsuitable for specific physical activities.
• Exercising on uneven surfaces.
• Taking medications like glucocorticoids or fluoroquinolone antibiotics.
• Having a chronic condition such as rheumatoid arthritis, lupus, gout, or diabetes that can weaken the Achilles tendon.

The risk of a ruptured Achilles tendon is higher under the following circumstances:

• Being assigned male at birth.
• Aged between 30 and 40 years.
• Engaging in sports involving extensive running and jumping.
• Receiving steroid injections in the ankle, which may weaken the nearby Achilles tendon.
• Carrying excess weight.

Achilles Tendon Injury Treatment

Minor to moderate Achilles tendon injuries typically heal naturally over time. To facilitate the healing process, you can take the following steps:

1. Rest your leg: Minimize weight-bearing activities and consider using crutches to alleviate pressure on the injured tendon.
2. Ice therapy: Apply ice to the injury for up to 20 minutes at a time to reduce swelling and discomfort.
3. Compression: Wrap an elastic bandage around the lower leg and ankle to help reduce swelling.
4. Elevation: Elevate your leg by propping it on a pillow while sitting or lying down to further reduce swelling.
5. Anti-inflammatory medication: Take nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen to alleviate pain and inflammation. Follow the dosage instructions on the label and consult your doctor if you have any concerns.
6. Heel lift: Consider using a shoe insert or heel lift as recommended by your doctor to protect the Achilles tendon from additional strain.
7. Stretching and strengthening exercises: Engage in exercises recommended by your doctor or physical therapist to promote healing and improve tendon strength.
8. Low-impact activities: Once cleared by your doctor, participate in activities like swimming that are gentle on the Achilles tendon and aid in recovery.

For mild sprains, your doctor may demonstrate taping techniques using kinesiology tape (KT tape) to relieve pressure on the Achilles tendon during activity. In severe cases, immobilization may be necessary using a walking boot, splint, cast, or night splint to maintain the foot in a flexed position and stretch the Achilles tendon while sleeping. Consult with your healthcare provider for personalized treatment recommendations based on the severity of your injury.

Conclusion

Achilles tendon injuries can occur due to various factors, ranging from athletic activities to everyday movements and predisposing conditions. While these injuries can be painful and debilitating, prompt recognition and appropriate management can significantly aid in recovery.

For minor to moderate injuries, a combination of rest, ice, compression, elevation, and anti-inflammatory medication can help alleviate symptoms and promote healing. Additionally, incorporating stretching and strengthening exercises, under the guidance of a healthcare professional, can enhance tendon flexibility and strength.

In cases where immobilization is necessary, techniques such as taping or bracing may be employed to provide support and facilitate healing. It’s essential to follow medical advice and adhere to prescribed treatments to prevent exacerbation of the injury and promote optimal recovery.

Moreover, individuals should be mindful of preventive measures, such as wearing appropriate footwear, engaging in proper warm-up and stretching routines, and gradually increasing activity levels to minimize the risk of Achilles tendon injuries.

By understanding the causes, symptoms, and treatment options for Achilles tendon injuries, individuals can take proactive steps to safeguard their tendon health and maintain an active lifestyle. Always consult with a healthcare professional for personalized assessment and management of Achilles tendon injuries.

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