Pediatric Achilles tendinitis

What is Achilles tendinitis?

Achilles tendinitis is a type of tendinopathy (tendon injury) that typically occurs from overuse. The Achilles tendon is the largest tendon in the body. This fibrous band of tissue connects the calf muscle in the lower leg to the heel bone. The tendon activates every time an athlete pushes from their heels to run, jump or go up on their tiptoes (“en pointe”). Doing these movements over and over can irritate the tendon and cause painful swelling. Our sports medicine specialists offer advanced care for this sports injury.

What are the different types of pediatric Achilles tendinitis?

The location of the tendon injury determines the type. An athlete may have one or both types of Achilles tendinitis.

Insertional Achilles tendinitis

Insertional Achilles tendinitis occurs in the area where the tendon inserts (attaches) to the lower part of the heel bone. Athletes who do a lot of running are more prone to this injury. But it also affects children who don’t play sports or aren’t very active.

Noninsertional Achilles tendinitis

Noninsertional Achilles tendinitis affects the middle part of the tendon above the heel. Fibers in this area start to break down, tear and thicken. This fiber damage can lead to a different type of tendinopathy called Achilles tendinosis. Noninsertional Achilles tendinitis is more common in young people who run or are very active.

What are the signs and symptoms of pediatric Achilles tendinitis?

• Musculoskeletal pain and stiffness in the back of the heel or calf muscle

• Pain that’s worse in the mornings, during physical activity or when pointing the toes

• Pain that gets worse when wearing shoes

• Swelling in the back of the heel that gets worse during the day or with activity

How is pediatric Achilles tendinitis diagnosed?

Achilles tendinitis causes symptoms similar to other overuse injuries like plantar fasciitis and Sever’s disease. An accurate diagnosis is critical to proper treatment and recovery. Our orthopedic specialists are experts at diagnosing all types of overuse injuries.

To diagnose Achilles tendinitis, our doctors:

• Perform a physical exam

• Evaluate symptoms

• Refer to images from an X-ray, MRI or ultrasoundto determine the injury type and severity

What causes pediatric Achilles tendinitis?

The primary causes of Achilles tendinitis include:

• Overuse or repeatedly performing the same movements

• Suddenly increasing the amount or intensity of activity

• Tight calf muscles

Other causes of Achilles tendinitis include:

• Enlarged bony bump on the back of the heel (Haglund’s deformity)

• Excess weight or obesity

• Flat feet or high arches

• Improperly fitted or unsupportive shoes

• Weak leg, ankle or foot muscles

How is pediatric Achilles tendinitis treated?

Without proper treatment and recovery, the Achilles tendon can weaken and tear. Our team creates a customized treatment plan to treat Achilles tendinitis and prevent more severe injuries like a ruptured Achilles tendon. By tailoring the treatment to an athlete’s unique injury and preferred activities, our team ensures a successful return to play as quickly as possible.

At the Andrews Institute, we offer a full spectrum of treatments and programs for athletes with Achilles tendinitis, including:

Nonsurgical treatments for Achilles tendinitis

Most athletes with Achilles tendinitis get symptom relief with nonsurgical treatments, such as:

• Limiting or stopping pain-inducing activities until symptoms improve

• Alternating cold and heat on the injured area throughout the day

• Custom orthotics like heel lifts

• Immobilization with removable braces, boots or night splints

• Nonsteroidal anti-inflammatory drugs (NSAIDs) or oral corticosteroids

• Plasma-rich platelet (PRP) injections

• Therapeutic ultrasound

Physical therapy and other rehab services for Achilles tendinitis

Our sports rehabilitation programs focus on promoting recovery, preventing an injury recurrence and returning athletes to their activities.

Athletes with Achilles tendinitis also benefit from:

• Physical therapy to stretch and strengthen the calf muscle and tendon, and improve flexibility.

• Bridge training via the Sports Performance powered by EXOS program to help athletes return to activities when they finish physical therapy or sports rehabilitation.

• Dance Sports Medicine Program to ease the transition back to dance at the end of physical therapy.

• Running Program to learn proper running techniques that lower the risk of reinjury.

Orthopedic surgeries to repair a torn Achilles tendon

An athlete who continues to have symptoms after six months of physical therapy and other nonsurgical treatments may need orthopedic surgery. Surgery also repairs a torn Achilles tendon.

Surgery to repair the tendon depends on the injury type and severity. Our pediatric orthopedic surgeons expertly perform:

• Tendon debridement to remove damaged tendon tissue, bone spurs or bony bumps. Surgeons then reattach the remaining healthy tendon to the heel bone. They may use metal or plastic anchors to hold the tendon in place while it mends.

• Tendon transfer to remove and replace the damaged tendon with a healthy tendon taken from the hip or different part of the body.

• Gastrocnemius (calf muscle) recession to surgically lengthen the calf muscle and improve ankle flexibility.