Updated: Oct 7, 2019
Cause: Equinus (tight Achilles tendon), injury, overuse, flatfoot, cavus foot, improper running technique, insufficient stretching
Appearance: Pain in the back of the ankle, stiffness when first standing up, sharp soreness with walking, irritation from the back of the shoe, increased heat to the Achilles, swollen ankle.
How to Diagnose: X-ray, clinical palpation, MRI, Ultrasound
- Stretching the Achilles is first line treatment (must be passive, never active)
o Eccentric training (see image)
o Night-splint stretching device (see image)
- Steroid injections are NOT indicated due to risk of rupture
- 2-4 weeks rest from tennis, followed by return to clay court first, followed by hard court
- Ice and anti-inflammatories (if ok to take)
- Compression sleeve
- Physical therapy
- 2-4 weeks in a immobilizing walking boot for severe cases
- Maximalist tennis shoes and orthotics/bracing ( for chronic cases) help prevent recurrence
- Prolotherapy is a new technique for recruiting stem cells – This involved injecting lidocaine and dextrose (sugar water) in to the tendon. The athlete is able to continue weightbearing throughout the treatment time. We have noticed 70-90% relief after 3 rounds of injections in tennis players
- PRP(Platelet Rich Plasma) has not been definitively shown to provide superior pain relief than prolotherapy, although some studies have shown good results.
- Surgery is an option only in cases where conservative care has failed.
o We do NOT recommend Achilles tendon lengthening procedures as an adjunct given its effects on the tennis serving motion and first step push off
o Debridement of diseased tendon with anchoring back into the calcaneus ( heel bone)
o Tendon transfers will have effects on first-step power, serve motion/power, this will need to be factored into decision making prior to agreeing to this permanent change in gait.
o Synthetic grafting has had issues in the literature with wounds and function.
Long-term prognosis: Once the diagnosis is made, stretching of the Achilles tendon before and after athletics is recommended indefinitely. Orthotics will help prevent recurrence and for chronic cases, bracing (OTC or custom) may be needed to continue playing at peak levels. Surgery recover can take up to a 1-year or more to get back to tennis. If the Achilles tendon is lengthened as part of surgery, push off power will be diminished, therefore, serve speed will diminish and time to react to shots will relatively diminish.
Who to call: Podiatrist, orthopedic surgeon