Achilles Paratenonitis

What is Achilles paratenonitis?

Achilles paratenonitis is a condition that involves swelling (inflammation) of tissue that covers your Achilles tendon. Achilles paratenonitis is common in runners, tennis players and dancers who perform repeated movements that stress their tendons. Marathon runners often develop the condition. It also affects people whose shoes don’t fit properly. Achilles paratenonitis can be short-term (acute) or long-term (chronic).

Your Achilles tendon is a band of tissue that links your heel bone (calcaneus) to your calf muscles in the back of each leg. It helps you run, climb, jump and walk. Left untreated, Achilles paratenonitis may worsen and make walking or running difficult. It may also injure your tendon. Early diagnosis and treatment are essential to ease symptoms and avoid complications so you can return to the activities you enjoy.

Other names for Achilles paratenonitis include:

• Achilles paratendonitis.
• Achilles peritendinitis.
• Achilles tenosynovitis.
• Achilles tenovaginitis.

What are the symptoms of Achilles paratenonitis?

Common symptoms of Achilles paratenonitis include:

• Difficulty standing or moving.
• Pain.
• Redness.
• Squeaking, popping or crackling sound (crepitus) when you move your ankle.
• Stiffness.
• Swelling.
• Tenderness.
• Warmth around your ankle or heel.

Symptoms of Achilles paratenonitis are similar to other conditions that cause ankle pain and Achilles tendon pain. They usually start gradually and worsen with exercise. Long-term paratenonitis may lead to ongoing tendon pain or a torn (ruptured) tendon. If symptoms persist or worsen, tell a healthcare provider as soon as possible.

What causes Achilles paratenonitis?

Overuse of your Achilles tendon or repeated movements that stress the layer of tissue (membrane) around it cause Achilles paratenonitis. The condition may also occur when you wear poorly fitted shoes or do intense running or jumping workouts. It’s a common sports injury.

You’re more likely to develop the condition if you:

• Don’t stretch enough or train properly for exercise or sports.
• Exercise or play sports on surfaces that are too hard or uneven.
• Have a disorder that affects the lower limbs.
• Have feet that are very flat or have high arches.

How is Achilles paratenonitis diagnosed?

Achilles paratenonitis can be difficult to diagnose because its symptoms resemble those of other conditions. Providers may misdiagnose injury to the paratenon as an ankle sprain.

You may observe signs of inflammation, or a healthcare provider may notice symptoms during a checkup. Providers diagnose Achilles paratenonitis using a physical exam where they move or press your tendon. You may be referred to a sports medicine specialist or foot and ankle surgeon for an evaluation.

What tests help diagnose Achilles paratenonitis?

Your provider may use imaging tests to accurately diagnose Achilles paratenonitis and recommend treatment. Imaging studies can help your healthcare provider determine the degree of injury. Tests may include:

• MRI.
• Ultrasound.
• X-ray.

How is Achilles paratenonitis treated?

In most cases, Achilles paratenonitis heals with RICE therapy:

• Rest.
• Ice.
• Compression (with sports tape or bandage).
• Elevation.

Providers generally don’t recommend steroid injections for tendon conditions due to the risk of weakening and rupturing the tendon.

Other nonsurgical treatments include:

• Contrast baths (using a hot then cold bath).
• Elevating your ankle.
• Nonsteroidal anti-inflammatory medications (NSAIDs) like ibuprofen.
• Physical therapy.
• Special footwear or changing the type of shoe you wear.
• Stretching or massage.
• Supportive devices like a heel lift, boot, cast or brace to keep the area still (immobilization).
• Brisement, a treatment that involves several sessions of injections (saline and local anesthetic), to break down scarred paratenon tissue.

Will I need surgery for Achilles paratenonitis?

Surgery to repair your tendon may be an option if you have severe or long-lasting symptoms. After surgery, you typically don’t return to intense physical activity for several months, giving your tendon time to recover. Your surgeon will let you know when it’s safe to return to your previous level of activity.

Is there a cure for Achilles paratenonitis?

In most cases, Achilles paratenonitis can be resolved. Follow your healthcare provider’s guidelines to ensure proper healing and avoid complications.

Who might be on your treatment team for Achilles paratenonitis?

If you have Achilles paratenonitis, a specialized care team handles the full range of symptoms. They may include:

• Foot specialist (podiatrist).
• Foot and ankle (orthopaedic) surgeon.
• Occupational therapist.
• Physical therapist.

How can I reduce my risk of developing Achilles paratenonitis?

You can reduce your risk of developing Achilles paratenonitis by following safe exercise practices and wearing appropriate, well-fitting shoes. Healthcare providers recommend that athletes and other active people:

• Stretch: Warm up your Achilles tendon and calf muscles before exercise to reduce the risk of injury.
• Change it up: Mix low-impact with high-impact activities, avoiding those that place too much stress on your Achilles tendons.
• Take your time: Slowly increase exercise intensity and difficulty, over time.
• Wear healthy footwear: Arch support reduces heel strain and tendon stress.

What’s the outlook for Achilles paratenonitis?

The outlook for Achilles paratenonitis depends on your overall health, age, the severity of your injury and the treatment you receive. In many cases, full recovery takes several months.

Recovery may take longer if you have surgery. Follow your healthcare provider’s instructions to ensure proper healing. Take time to discuss your options so you know what to expect.

When should I seek care?

Early detection and treatment of Achilles paratenonitis is important. This condition can make walking, running or jumping difficult. It can also lead to Achilles tendon tearing (rupture), which requires surgery. Your healthcare provider will work with you to develop a personalized care plan to meet your needs.