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Achilles tendinitis is the term often used to describe pain at the back of the ankle over the Achilles tendon. Tendinitis or inflammation of the tendon is not usually the cause of pain in the achilles tendon but there can be a number of different causes of achilles pain.
We outline below the most common causes of a achilles pain as well as some of the less common causes and conditions not to be missed.
Common causes of achilles tendon pain
Achilles tendon rupture is when there is a complete or partial rupture of the achilles tendon. A complete achilles rupture tends to affect older men who are recreational athletes and may have a history of achillles pain and degeneration of the achilles tendon. The athlete may feel as if they have been physically struck in the back of the ankle as well as feeling a sharp pain and a loud snap or bang noise.A gap may be seen or felt in the tendon and Thompson's test can help confirm the diagnosis. Often they are able to limp on but should seak emergency medical attention immediately.
A partial achilles tear may cause a sudden sharp pain in the achilles although this may not be felt at the time for a mild strain. Pain will be worse the next morning after the achilles has had time to stiffen up. A small swelling my also be visible in the tendon.
Achilles tendonitis or achilles tendinopathy is probably a better term to describe the range of conditions that can cause achilles tendon pain. Achilles tendinitis is commonly used but true inflammation of the tendon is less common than a degeneration of the achilles tendon. Achilles tenosynovitis is an inflammation of the sheath surrounding the achilles tendon. All these conditions have similar symptoms and usually respond well to similar treatment approaches.
Posterior impingement syndrome is where a bony growth at the back of the ankle impinges the movement of the bones causing pain. This can happen at the front of the ankle (known as anterior impingement) or at the back resulting in pain around the achilles area but not actually on the achilles tendon itself.
Insertional achilles tendinopathy is inflammation or degeneration of the tendon at the point which it inserts into the bone at the back of the heel. Symptoms will include pain directly at the back of the heel although it is possible this occurs in conjunction with Achilles tendinitis in which case the pain will be felt in the actual Achilles tendon itself.
Haglunds syndrome is diagnosed when both achilles tendinitis and achilles bursitis (inflammation of the bursa at the back of the heel) occur at the same time in the same leg.
Sever's disease affects children between the ages of 8 and 15 causing pain and inflammation at the back of the heel where the achilles inserts. It is similar to insertional achilles tendinitis but affects children. This injury is similar to Osgood Schlatter's disease of the knee and needs plenty of rest. It is something the young athlete should grow out of as long as it is looked after and treated correctly.
Less common causes of achilles pain
Achilles bursitis is inflammation of the bursa or sack of fluid at the back of the ankle.Symptoms include pain at the back of the heel which my become worse when running uphill or on soft surfaces. A spongy resistance may be felt when pressing in either side of the back of the heel. There is likely to be tenderness with a small swelling at the back of the heel.
Referred pain from the lumbar spine is unusual but should be considered in the case of a persistent Achilles injury that just won't heal.
Accessory Soleus muscle is an extra muscle which is thought to be present in 6% of people. Problems with this muscle are more common in men around the age of 20 than in women. Ultrasound, CT and MRI scans can all confirm the presence of the muscle. If symptoms are bad enough then surgery is considered.
Do not miss
Referred pain from the lower back or sciatic nerve. Pressure on the sciatic nerve can cause pain to radiate down the leg or simply appear is if it is coming from the ankle or achilles tendon.
Achilles tendon rupture as mentioned above is a serious injury requiring immediate treatment, preferably with surgery. However, it is possible the athlete did not realize what they had done at the time and carried on regardless. Over time full use of the ankle will not be restored although the soleus muscle will compensate to a certain extent.
Achilles tendinopathy due to inflammatory arthropathies