Achilles Tendon Calcification: Causes, Symptoms, and Treatments

What Is Achilles Tendon Calcification (Calcific Tendonitis)?

Achilles tendon calcification is a condition characterized by the accumulation of calcium deposits in the Achilles tendon, which connects the calf muscles to the heel bone. The achilles tendon insertion, where the tendon attaches to the heel bone, is a common site for these deposits. Calcific tendinopathy is a related term used to describe conditions involving calcium deposits in tendons, often leading to similar symptoms and complications. This buildup can lead to inflammation, pain, and restricted movement. The exact cause of Achilles tendon calcification is not fully understood, but it is often associated with repetitive strain, overuse, injury to the tendon, or tightness and issues in the calf muscle.

Common symptoms include pain at the back of the heel, stiffness, and swelling, particularly after physical activity [[1]](LINK 1).

Symptoms of Achilles Tendon Calcification

Patients with Achilles tendon calcification may experience a variety of symptoms in the affected tendon, including:

• Localized Pain: Pain at the back of the heel, with pain worse during certain activities or after increased use.
• Stiffness: Stiffness in the tendon, especially in the morning or after prolonged periods of inactivity.
• Swelling: Noticeable swelling around the tendon.
• Reduced Range of Motion: Difficulty flexing the foot or performing activities that require ankle movement.
• Crepitus: A crackling or popping sensation when moving the tendon.

Related Conditions

Several conditions are closely related to Achilles tendon calcification and can present with similar symptoms. Achilles tendonitis, which can be either insertional (affecting the lower portion of the tendon near the heel bone) or noninsertional (affecting the middle portion of the tendon), often leads to pain, swelling, and reduced mobility. Retrocalcaneal bursitis is another related condition, involving inflammation of the bursa located between the Achilles tendon and the heel bone, which can cause additional heel pain and swelling. Haglund’s deformity, characterized by a bony spur on the back of the heel bone, can also irritate the Achilles tendon and contribute to discomfort. These conditions may require similar approaches to management, including physical therapy, non surgical treatments to reduce pain and inflammation, and, in some cases, surgical options to address persistent symptoms or structural abnormalities.

Diagnosis of Achilles Tendon Calcification

Diagnosing Achilles tendon calcification typically involves a thorough physical examination and imaging tests. Healthcare providers may use ultrasound or MRI to confirm the diagnosis and assess the extent of calcification.

In many cases, healthcare providers will order imaging tests such as X-rays to further evaluate the condition and distinguish it from other possible injuries.

Doctors diagnose calcific tendonitis by combining findings from the clinical examination with results from imaging tests, which help confirm the presence of calcium deposits in the tendon and guide treatment decisions.

These imaging techniques help visualize the tendon and surrounding structures, allowing for a comprehensive evaluation of the condition. On X-rays, bone spurs and other calcifications or deformities at the heel may also be visible, providing additional information for diagnosis and treatment planning.

Treatment Options for Achilles Tendon Calcification

Conservative Treatments

• Rest and Activity Modification: Avoiding activities that exacerbate symptoms.
• Physical Therapy: Exercises to improve flexibility and strengthen the calf and ankle muscles.
• Pain Management: NSAIDs or corticosteroid injections to reduce inflammation and pain.
• Heat/Ice Therapy: Applying heat or ice to alleviate pain and swelling.
• Heel Lifts: Using heel lifts in shoes to reduce strain on the Achilles tendon and decrease irritation.
• Shoe Wear Modification: Adjusting footwear or using orthotic devices as part of conservative management to help alleviate symptoms.
• Removable Boot or Walking Boot: Using a removable boot or walking boot for immobilization during recovery to support healing and limit movement.

Prolotherapy

In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat Achilles tendon calcification.

Published research has proven its pain-relieving, anti-inflammatory, and regenerative benefits.

Prolotherapy involves injecting a natural regenerative solution with tiny needles. This has been shown to stimulate the production of collagen cells, the small cells needed to help with Achilles tendon calcification.

As prolotherapy is helping to treat the root cause of Achilles tendon calcification, it is deemed to be a permanent fix, preventing the symptoms from returning [4].

Disclaimer: The information provided in this section is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Prolotherapy may not be suitable for everyone, and outcomes can vary. Always seek the guidance of a qualified healthcare professional regarding your specific medical condition or treatment options. Never disregard professional medical advice or delay seeking it because of information you have read here.

Other Interventions

• Extracorporeal Shock Wave Therapy: Extracorporeal shockwave therapy (ESWT) is a non-invasive treatment that uses shockwaves to break down calcium deposits and promote healing by stimulating the body’s natural tissue repair processes.
• Surgery: In severe cases, surgical intervention may be necessary to remove calcium deposits and repair damaged tendon tissue. Surgical techniques can involve an open incision, which is the traditional approach, or a smaller incision for minimally invasive procedures, each with different risks and recovery profiles. After removal of damaged tissue, the remaining tendon may be reattached to the heel bone, and if the remaining tendon is insufficient, additional procedures such as tendon transfer may be required.
• Gastrocnemius Recession: For patients with tight calf muscles that limit ankle mobility and increase stress on the Achilles tendon, gastrocnemius recession is a surgical option. This procedure lengthens the calf muscle to improve flexibility and reduce tendon strain, and can be performed using either an open incision or a smaller incision technique.

Exercises for Rehabilitation

Rehabilitation exercises are a cornerstone of recovery for those with Achilles tendon injuries or following surgery. Eccentric exercises, which involve slowly lowering the heel below the level of a step while bearing weight, are particularly effective for promoting healing and reducing pain in the Achilles tendon. These exercises help remodel damaged tendon fibers and improve tendon strength. Common examples include heel drops and calf raises, which target both the Achilles tendon and the supporting calf muscles. Strengthening the calf muscles through exercises like toe curls and heel raises can further reduce stress on the Achilles tendon and enhance ankle stability. It is important to perform these exercises under the supervision of a physical therapist, who can tailor the program to your specific needs and ensure proper technique, progression, and safety. Consistent rehabilitation can help restore function, reduce pain, and prevent future injuries.

Lifestyle Modifications for Ongoing Health

Maintaining the health of the Achilles tendon and preventing future problems often requires making thoughtful lifestyle changes. Avoiding repetitive stress and overuse—such as sudden increases in exercise intensity or duration—can help protect the tendon from injury. Wearing supportive shoes that provide adequate cushioning and stability is essential, especially for those with a history of Achilles tendon issues or calcific tendonitis. Incorporating regular stretching and strengthening exercises into your daily routine can improve flexibility and resilience of the tendon. Managing metabolic disorders, maintaining a healthy weight, and avoiding smoking are also important steps in reducing extra stress on the Achilles tendon and supporting overall tendon health. Early treatment of any symptoms or injuries, along with these lifestyle modifications, can significantly lower the risk of developing calcific tendonitis and promote long-term mobility and well-being.

Long-Term Effects of Achilles Tendon Calcification

While many patients experience relief from symptoms with appropriate treatment, some may face long-term effects from Achilles tendon calcification. Chronic pain, reduced mobility, and ongoing discomfort can significantly impact daily activities and quality of life. If left untreated, Achilles tendon calcification can lead to permanent damage to the tendon and surrounding tissues, resulting in chronic pain and functional limitations.

Case Study: Successful Recovery

A 50-year-old patient with Achilles tendon calcification underwent a combination of physical therapy and prolotherapy. After three months of treatment, the patient reported a significant reduction in pain and improved ankle function, allowing a return to normal activities. This case highlights the effectiveness of a comprehensive treatment approach.

Factors Influencing Long-Term Outcomes

Several factors can influence the long-term effects of Achilles tendon calcification:

• Severity of the Condition: More severe cases may lead to greater long-term complications.
• Age: Older individuals may experience slower recovery and more significant long-term effects.
• Adherence to Treatment: Following prescribed treatment plans can improve outcomes.
• Lifestyle Choices: Maintaining a healthy weight, engaging in regular exercise, and strengthening the lower leg muscles can support recovery and reduce long-term effects.

The Importance of Early Intervention

Taking action early when dealing with Achilles tendon calcification can make a significant difference in your recovery and long-term outcomes. Early intervention with conservative treatment options—such as physical therapy, pain medication, and steroid injections—can help relieve pain, reduce inflammation, and restore function before more serious complications develop. In cases where conservative measures are not enough, surgical treatment options may be recommended to relieve pressure on the tendon and stabilize the ankle. Working closely with a physical therapist can help you develop a personalized plan that includes strengthening exercises, stretching, and pain management techniques tailored to your needs. By addressing Achilles tendon calcification early, you can improve your chances of a full, pain free recovery and reduce the risk of chronic pain or permanent damage.

Preventing Further Complications

Preventing additional problems from Achilles tendon calcification requires a proactive and comprehensive approach. Maintaining a healthy weight reduces stress on the tendon, while avoiding improper lifting techniques can help prevent further injury. It is also important to take steps to avoid a specific injury, such as an acute trauma or sudden tear, which can cause significant Achilles tendon damage and may require different treatment. Incorporating regular exercise, especially strengthening exercises and stretching, supports tendon health and helps reduce the risk of future injuries. By working with your healthcare team and making positive lifestyle changes, you can help relieve pain, support your tendon health, and minimize the risk of long-term issues associated with Achilles tendon calcification.

When to Seek Medical Help

Seek immediate medical attention if you experience:

• Severe pain that does not improve with rest
• Loss of function in the ankle or foot
• Signs of infection, such as fever or swelling

These may indicate a more serious condition requiring prompt medical intervention.

Frequently Asked Questions

What is Achilles tendon calcification?

Achilles tendon calcification is a condition characterized by the accumulation of calcium deposits in the Achilles tendon, leading to pain and inflammation.

Anatomy of the Achilles Tendon

The Achilles tendon is the largest tendon in the human body, connecting the powerful calf muscles—specifically the gastrocnemius and soleus—to the heel bone, or calcaneus. This robust tendon is essential for everyday movements such as walking, running, jumping, and standing on tiptoes. It acts as a critical shock absorber and helps transfer the force generated by the calf muscles to the foot, enabling smooth and efficient movement of the ankle joint. Because of its vital role and constant use, the Achilles tendon is susceptible to injuries and conditions like Achilles tendonitis and calcific tendonitis, which can significantly impact mobility and quality of life. Understanding the anatomy of this large tendon is key to recognizing how issues such as pain, swelling, or stiffness can develop and how they can be effectively managed.

Causes and Risk Factors for Calcification

Calcification of the Achilles tendon occurs when calcium deposits accumulate within the tendon, leading to discomfort, stiffness, and reduced flexibility. While the precise cause of calcific tendonitis remains unclear, several factors are known to increase the risk. Repetitive stress or overuse of the Achilles tendon—common in athletes and individuals with active lifestyles—can contribute to microtrauma and degeneration of the tendon fibers. As people age, the tendon naturally loses some of its elasticity and blood supply, making it more prone to injury and calcium buildup. Previous injuries or trauma to the tendon, as well as underlying metabolic or systemic disorders, can also predispose individuals to calcification. Insertional Achilles tendinitis, which affects the area where the tendon attaches to the heel bone, is another significant risk factor, as chronic inflammation in this region can lead to the formation of calcium deposits and the development of calcific tendonitis.

Can Achilles tendon calcification heal on its own?

Yes, many cases of Achilles tendon calcification improve with conservative treatments, but some may require more advanced interventions if symptoms persist.

Is surgery necessary for Achilles tendon calcification?

Surgery is typically reserved for severe cases that do not respond to conservative treatments. Most patients find relief through non-surgical methods.

How effective is prolotherapy for Achilles tendon calcification?

Prolotherapy has shown promising results in reducing pain and promoting healing in patients with Achilles tendon calcification, especially when combined with other conservative treatments.

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Author Bio

Having performed over 10,000 procedures, Mr Oliver Eaton is one of the UK’s leading practitioners in the field of treating Achilles tendon calcification, with patients travelling to see him from across the UK, Europe, and the Middle East.

With over 12 years of clinical experience, Oliver is dedicated to helping patients understand their symptoms associated with Achilles tendon calcification and providing effective treatment options to alleviate them.

He qualified in Prolozone Therapy and Prolotherapy in America with the American Academy of Ozonotherapy. He continued on to complete further qualifications at the Royal Society of Medicine, Charing Cross Hospital in London, Keele University’s Anatomy & Surgical Training Centre, and the medical department of Heidelberg University in Germany.

Over the years he has had the privilege of treating many elite-level athletes, including both Olympic and Commonwealth medallists.

Mr Eaton’s expertise has been featured in many national news and media publications, including The Telegraph, The Daily Mail, The Daily Express, Women’s Health Magazine, and The Scotsman.

LinkedIn profile

References

1. 1. 1. National Institute of Neurological Disorders and Stroke. (2023). Herniated Disc. https://www.ninds.nih.gov/health-information/disorders/herniated-disc
         • Harvard Health Publishing. (2022). Herniated disk: What you need to know. https://www.health.harvard.edu/pain/herniated-disk-what-you-need-to-know
         • Chou, R., et al. (2018). Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline. Annals of Internal Medicine, 168(7), 514-530.
         • Rabago, D., et al. (2016). Prolotherapy in Primary Care Practice. Primary Care: Clinics in Office Practice, 43(2), 329-338. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4913113/

Disclaimer: This article is for informational purposes only and does not substitute for professional medical advice. Always consult your healthcare provider before making treatment decisions.