Achilles Tendinitis Facts

Overview


Achilles TendonitisAchilles Tendonitis is an inflammation of the Achilles Tendon. This tendon attaches the muscles in the calf of the leg to the back of our heels. The Achilles Tendon is a long and thick tendon, which moves our foot down, so that the toes point to the ground (plantar flexion). This tendon can become inflamed due to the following causes. Over utilizing it, such as too much running, especially up or down hill. Trauma, such as a kick to the tendon. Shoe or boot pressure, especially at its attachment to the heel, or just above it. There are over 250,000 injuries to the Achilles Tendon annually. In fact, more Than 10% of all running injuries are to the Achilles tendon. Tendonitis may be classified as either acute or chronic. Acute Achilles Tendonitis comes on quickly, usually after a specific activity or event. It is characterized by an overstretching or tearing of some of the small fibers of the tendon, and causes pain or tenderness when walking or running. It can occur at the insertion (near the attachment to the heel bone, or further up the leg, about 4 or 5 inches above the heel. Acute tendonitis can also follow a specific injury, such as a kick to the tendon while playing soccer. Chronic Achilles Tendonitis develops gradually over time. Many times, you can feel an obvious thickening of the tendon that may be tender when squeezed, due to long standing scarring of the tendon. Pain is also present when walking or during other forms of activity, and feels better at rest.






Causes


The calf is under a lot of strain when running: it is not only put on stretch during landing of the foot, but it also has to produce the tension needed to support body weight and absorb the shock of landing. This is what is called an ?eccentric load?. Excessive eccentric loading - either by way of a dramatic increase in mileage, or excessive hill running, or faulty running posture - could very well be the cause of a runner?s achilles tendinitis. The calf strain translates downward into the achilles tendon where it attaches to the heel, and inflammation ensues. Inflammation then causes scarring and fibrosis of tissues, which in turn inflicts pain upon stretching or use. Risk factors for Achilles tendinitis also include spending prolonged amounts of time standing or walking.






Symptoms


Mild ache in the back of the lower leg, especially after running. More acute pain may occur after prolonged activity, Tenderness or stiffness in the morning. In most cases the pain associated with Achilles tendinitis is more annoying than debilitating, making sufferers regret activity after the fact, but not keeping them from doing it. More severe pain around the Achilles tendon may be a symptom of a much more serious ruptured tendon.






Diagnosis


The diagnosis is made via discussion with your doctor and physical examination. Typically, imaging studies are not needed to make the diagnosis. However, in some cases, an ultrasound is useful in looking for evidence of degenerative changes in the tendon and to rule out tendon rupture. An MRI can be used for similar purposes, as well. Your physician will determine whether or not further studies are necessary.






Nonsurgical Treatment


Treatment options might include anti-inflammatory medication such as ibuprofen which might help with acute achilles inflammation and pain but has not been proven to be beneficial long term and may even inhibit healing. If the injury is severe then a plaster cast might be applied to immobilize the tendon. Use of electrotherapy such as ultrasound treatment, laser therapy and extracorporeal shock wave therapy (ESWT) may be beneficial in reducing pain and encouraging healing. Applying sports massage techniques can mobilze the tissues or the tendon itself and help stretch the calf muscles. Some might give a steroid injection however an injection directly into the tendon is not recommended. Some specialists believe this can increase the risk of a total rupture of the tendon in future. One of the most effective forms of treatment for achilles tendonitis is a full rehabilitation program consisting of eccentric strengthening exercises. There is now considerable evidence suggesting the effectiveness of slow eccentric rehabilitation exercises for curing achilles tendon pain.


Achilles Tendon






Surgical Treatment


Your doctor may recommend surgery if, after around six months, other treatments haven?t worked and your symptoms are having an impact on your day-to-day life. Surgery involves removing damaged areas of your tendon and repairing them.






Prevention


To prevent Achilles tendonitis or tendonosis from recurring after surgical or non-surgical treatment, the foot and ankle surgeon may recommend strengthening and stretching of the calf muscles through daily exercises. Wearing proper shoes for the foot type and activity is also important in preventing recurrence of the condition.

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