Calcific Achilles tendonitis: Causes and treatment

Calcific Achilles tendonitis is when your usual tendonitis is accompanied by some calcification in your Achilles tendon. This article explains that it is not always necessary to have surgery for calcific Achilles tendonitis and how to tweak your normal Achilles tendonitis recovery programme if you have calcific tendonitis. Remember, if you need more help with an Achilles injury, you're welcome to consult one of our team via video call.

The terms tendinitis, tendonitis, tendinosis, and tendinopathy mean the same thing for all practical purposes, and we use these interchangeably in our articles.

In this article:

1. What is calcific Achilles tendonitis?

2. What causes calcification in the Achilles tendon?

3. How does calcification affect recovery from Achilles tendonitis?

4. How do you treat calcific Achilles tendonitis?

5. How we can help

We've also made a video about this:

What is calcific Achilles tendonitis?

Calcific Achilles tendonitis or tendinopathy is when calcium deposits form inside your tendon in addition to the normal structural changes that affect your tendon when you have a tendinopathy or tendonitis.

The most common area for calcific tendonitis in the Achilles tendon is where it inserts into the heel bone. When the calcium deposits form on the heel bone itself, it is called a calcific spur (not to be confused with Haglund's Deformity).

X-ray showing a calcific spur and calcifications in the Achilles tendon at its insertion into the heel bone. (Johansson et al. 2012)

What causes calcification in the Achilles tendon?

We don’t actually know. Researchers suspect that it happens when your tendon gets injured (overuse, tear, direct blow, etc.) and then something interferes with the normal healing process.

There is relatively strong evidence that metabolic disorders like diabetes, hypothyroidism (underactive thyroid), and hypercholesterolemia (high cholesterol) can predispose you to calcific tendonitis. We know that these conditions can affect the body’s ability to heal. Drugs may play a role; statins (which are often used to treat high cholesterol) have been shown to lead to calcific tendonitis in rats.

However, healthy young athletes who don’t have any of these conditions also develop calcific tendonitis. In their case, it might be linked to not allowing their tendon enough time to recover and trying to do too much activity too soon after having injured it.

We need more research in this area. All we can say for now is that there are several factors that may play a role.

How does calcification affect recovery from Achilles tendonitis?

The research is lacking in this field also, but in our experience patients who have calcific tendonitis:

• Usually report much higher pain levels;

• Flare up their Achilles tendons much easier, and it can be disproportionately painful;

• Need their rehab to be progressed at a much slower pace; and

• Have tendons that are usually more sensitive to being stretched, and it can help to do their heel raise exercises initially with shoes on and only at floor level.

The research also suggests that you may be at an increased risk of rupturing your Achilles tendon when you have calcific tendonitis. So, it would be prudent to stay away from high-load activities until you’ve progressed your exercises to a high enough level and restored your tendon’s strength.

How do you treat calcific Achilles tendonitis?

The treatment for calcific Achilles tendonitis is exactly the same as for regular Achilles tendonitis. You just have to be a bit more careful and gentle with your exercises, as these cases often flare up more easily (as mentioned above). It is also important to treat any underlying conditions (diabetes, high cholesterol, underactive thyroid) that may have contributed to this injury.

One of patients' biggest fears when they hear that they have calcifications in their Achilles tendon is that they will require surgery. This is not necessarily the case. Some people may require surgery, but it’s also possible to recover without it.

Of 101 study participants that Giai Via and colleagues identified as having calcifications in their Achilles tendon, only 3% reported symptoms associated with it. The other 97% were leading normal lives without any associated problems. This shows that your Achilles tendon can be pain-free despite having calcifications.

How we can help

Need more help with your Achilles injury? You’re welcome to consult one of the team at TMA online via video call for an assessment of your injury and a tailored treatment plan.

We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Treat My Achilles we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.

About the Author

Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Master's Degree in Sports Injury Management. Follow her on LinkedIn or ResearchGate.

References:

1. Oliva, F., et al. (2012). "Physiopathology of intratendinous calcific deposition." BMC Medicine 10(1): 1-10.

2. Giai Via, A., et al. (2022). "Insertional calcific tendinopathy of the Achilles tendon and dysmetabolic diseases: an epidemiological survey." Clinical Journal of Sport Medicine 32(1): e68-e73.

3. Kaleağasıoğlu, F., et al. (2017). "Statin-induced calcific Achilles tendinopathy in rats: comparison of biomechanical and histopathological effects of simvastatin, atorvastatin and rosuvastatin." Knee Surgery, Sports Traumatology, Arthroscopy 25(6): 1884-1891.

4. Johansson, K. J. J., et al. (2012). "Calcific spurs at the insertion of the Achilles tendon: a clinical and histological study." Muscles, Ligaments and Tendons Journal 2(4): 273.

5. Maffulli, Nicola, Jason Wong, and Louis C. Almekinders. "Types and epidemiology of tendinopathy." Clinics in Sports Medicine 22.4 (2003): 675-692.