Achillodynia

Mareike Müller is a freelance writer in the medical department and assistant doctor for neurosurgery in Düsseldorf. She studied human medicine in Magdeburg and gained a lot of practical medical experience during her stays abroad on four different continents.

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Achillodynia is painful damage to the Achilles tendon. The disease occurs almost exclusively in active people and is one of the most common sports injuries. The cause is usually a long period of incorrect or excessive strain on the Achilles tendon. Typical of achillodynia is load-dependent pain in the area of the rear lower leg and heel. Non-operative methods are mostly used for achillodynia therapy. If the damage is recognized and treated in good time, progress can be prevented or at least slowed down. Here you can read everything you need to know about achillodynia.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. M76

Achillodynia: description

Achillodynia ("dynie" = pain) describes a painful condition of the Achilles tendon that usually occurs after an unusually heavy load. The symptoms usually subside on their own after a few days of rest. However, they can reappear at any time after they have been used again. Achillodynia is not the result of an acute injury to the Achilles tendon, but rather the result of long-term improper or overloading. Over the course of a few years, the Achilles tendon is gradually damaged structurally ("degenerative changes").

Achillodynia is one of the most common forms of sport damage and primarily affects professional athletes. But amateur athletes can also suffer from it. Sports with high running and jumping loads are typical triggers for achillodynia. Doctors assume that around ten percent of all joggers are familiar with this state of pain. Overall, more men than women develop the Achilles tendon. In about 40 percent of the cases, those affected have bilateral achillodynia. The occurrence of the disease without exercise is extremely rare.

Achillodynia usually begins around the age of 30. The patients have then been exercising for an average of twelve years. Cases have been reported in which achillodynia appeared after just four years of training. Other patients do not become ill until 20 years after starting training.

Anatomy and physiology of the Achilles tendon

The Achilles tendon is the thickest and strongest tendon in the human body. It is the common end tendon of the three-headed calf muscle (Musculus triceps surae), which attaches to the heel bone. The Achilles tendon transfers the force of the calf muscle to the foot. When the calf muscle contracts (muscle contraction), the foot is lowered by the toes. This is necessary, for example, when standing on your toes, running or jumping. With achillodynia, these movements are often difficult or painful. Movements that passively stretch the Achilles tendon, such as lifting your toes when walking uphill, are also painful.

The Achilles tendon can withstand high loads. However, it is also often affected by injuries. The blood supply is poor in some areas of the Achilles tendon, which is why damage to the Achilles tendon does not always heal completely. After a few years, this can result in achillodynia or a tear in the Achilles tendon.

Achillodynia: symptoms

Achillodynia is manifested by load-dependent pain in the Achilles tendon. When it hurts depends on the extent of the damage: In the early stages of achillodynia, patients only complain of pain after unusually heavy use. Most of the time, the pain occurs about a day after the exercise and subsides on its own in the following days.

Other typical complaints of achillodynia:

The pain can occur with active movement of the foot (standing on your toes) as well as with passive stretching of the Achilles tendon (heel gait).
The Achilles tendon hurts when you press on it and may already be a little thickened.
The skin over the tendon may be red and overheated from the inflammatory irritation.
Swelling in the area of the Achilles tendon is possible.
In some sufferers, the Achilles tendon grinds audibly when the foot is moved (signs of crepitation).
The complaints are mainly one-sided. However, both sides can also be affected at the same time.

Advanced achillodynia
If the achillodynia progresses further, the pain can already be felt during or immediately after moderate exercise. The Achilles tendon is now somewhat thickened in response to the continued overload. The pain disappears if you take it easy, but it comes back when you put pressure on again. Some sufferers complain of pain, especially when they warm up. Often at this stage, the level of suffering is already great, since sporting activities are only possible with pain.

If achillodynia is very advanced, the structural damage to the Achilles tendon is so great that permanent pain at rest can develop. Even at this stage, everyday stress such as walking is very painful. The quality of life is often severely restricted. Complete regeneration of the severely damaged tendon is hardly possible at this stage.

Achillodynia: causes and risk factors

Achillodynia mainly arises due to incorrect loading or overloading of the Achilles tendon during sport. This is often the case with professional track and field athletes, but recreational athletes can also be affected, especially runners. But football and tennis players, triathletes and ballet dancers also have more frequent problems with achillodynia. Because especially fast running and jumping movements lead to an increasing wear and tear of the Achilles tendon. Doctors refer to this wear and tear as "degenerative change". It mainly arises in the lower part of the Achilles tendon near the tendon attachment on the heel. There, the blood flow to the Achilles tendon is usually poor, which is why injuries do not heal as well.

Stress constantly causes tiny damage (microtraumas) to the Achilles tendon within the tendon. If the tendon is regularly overloaded, there is a disproportion between the many small microtraumas on the one hand and the rather limited ability of the Achilles tendon to regenerate on the other. How quickly achillodynia develops in the individual case is very different. This is influenced by various factors:

External factors

Training condition: The worse the general physical condition of training, the less resilient are the tendons of the body.
Type of load: Running and jumping in particular cause damage to the Achilles tendon.
Frequency and duration of exposure
Intensity of exercise
Recovery breaks: Athletes who do not regenerate sufficiently have a higher risk of degenerative changes in the Achilles tendon.
Incorrect footwear when exercising: Inappropriate footwear can lead to incorrect loading of the foot, which puts excessive strain on the Achilles tendon.
Incorrect footwear in everyday life: If women wear high heels for a long time, the Achilles tendon can shorten and thus cause achillodynia.
Cortisone therapy: Cortisone can damage the connective tissue and thus the tendons.

Internal factors

Age: The older a person is, the lower the ability to regenerate is usually.
Weight: Being overweight leads to permanent overloading of all tendons and joints in the body.
Foot malpositions: For example, arched feet or a weak ligament in the upper ankle joint put excessive strain on the Achilles tendon.
Metabolic diseases: diseases with high levels of uric acid and fat in the blood can damage tendons, for example in the case of gout.

Achillodynia: examinations and diagnosis

The right person to contact if you suspect achillodynia is an orthopedic specialist. At the doctor's appointment, the doctor will first ask you questions about the current symptoms and any previous illnesses or operations (anamnesis discussion). This can be, for example:

Where exactly is the pain?
When does the pain occur?
Is there anything that will ease the pain?
How often do you exercise?
What sport do you practice?

You will also be physically examined. For achillodynia to be diagnosed, you must lie down on your stomach. The doctor then takes your Achilles tendon between two fingers. This “pincer grip” can hurt people with achillodynia. The doctor also feels whether the Achilles tendon is thickened or swollen. The medic will also move your foot and ask you to walk on your toes and heels if necessary. In order to differentiate Achillodynia from other diseases of the Achilles tendon, further imaging examinations are usually necessary.

Further investigations

A partial tear of the Achilles tendon, inflammation of the tendon sheath or a heel spur can cause similar symptoms and must be differentiated from achillodynia. This is possible with imaging methods such as magnetic resonance tomography (MRT, "nuclear spin"), ultrasound and, if necessary, X-rays. Nowadays, an MRI is the first choice. Above all, deep layers of the Achilles tendon can be shown, which are often affected in achillodynia. The ultrasound serves to rule out a torn tendon and is often used to document the course of the disease. Possible calcifications of the Achilles tendon and bony injuries to the foot can be seen in the X-ray image.

Achillodynia: Treatment

Achillodynia therapy is usually purely conservative, not surgical. Only if this achillodynia treatment is unsuccessful is surgery necessary in rare cases.

Conservative achillodynia therapy focuses on relieving the Achilles tendon, especially in the case of acute complaints. To do this, you first have to suspend the triggering load (e.g. jogging) and protect your foot as much as possible. It may only be fully used again when the pain has completely subsided. In addition, pain relievers such as paracetamol, ibuprofen or diclofenac are administered. If the pain occurs right after exercising, it helps to cool the Achilles tendon. If the condition has completely disappeared after several days, however, the tendon should be warmed to promote the healing process. Special insoles for footwear also help with achillodynia. Exercises you learn in physical therapy will teach you how to put weight on the foot in the right way. There is also the option of attaching kinesiological tapes. Some doctors also recommend injecting substances such as glucose or "Actovegin" onto the tendon to accelerate wound healing. However, the effectiveness of these syringes has not been scientifically proven.

In a surgical treatment of achillodynia, either the tendon skin (peritendineum) is split or parts of the changed tissue are removed (debridement). The operation is only useful as a measure if the conservative therapy has not worked for a long period of time. The patient must be aware that the symptoms of achillodynia can persist even after the operation. In addition, the surgical treatment carries the risk of scarring the tendon, which can also cause pain. The tendon can also tear more easily after the operation.

Achillodynia: disease course and prognosis

Sport is generally the most important risk factor for developing achillodynia. However, achillodynia is not necessarily the result of any physical activity. Therefore, those affected do not necessarily have to forego sport. The way it is operated has a major impact on the course of the disease and the prognosis of the disease.

Basically, every athlete should make sure to take enough breaks between the individual training units. It is also important to warm up before exercising and to be careful not to overload the body while exercising. Even these three simple basic rules can help to minimize damage to the Achilles tendon and promote regeneration.

In addition, you should pay attention to the right footwear during training and in everyday life. Get advice from an orthopedic shoemaker in a specialist shop and in the event of foot misalignments. Women should be careful not to wear high-heeled shoes for too long or too often. This can lead to tendon shortening and subsequently to achillodynia even without physical activity. Especially when women start jogging again and otherwise wear high heels in everyday life, they have a significantly increased risk of developing achillodynia.

Achillodynia often goes away when the stress is removed. If you give the Achilles tendon time to recover and consistently omit the triggering sport or the wrong footwear until it is completely pain-free, you can achieve freedom from pain. However, with advanced achillodynia, the Achilles tendon can sometimes be so damaged that there is permanent pain when exercising or at rest. If those affected take their symptoms seriously at an early stage and follow the tips outlined above, achillodynia can be prevented in many cases.

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