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Achilles Tendinitis

Overview

Achilles TendinitisAchilles tendinitis can be a very crippling issue for runners - simply because the pain is enough to discourage loading of the foot. It can also be a tricky condition to treat because the tendon is not as heavily vascularized (i.e. more blood flow) as muscle, and therefore lacks healing potential. It is highly recommended that you see a physical therapist as soon as you experience acute symptoms, so chronic tendonosis (which is longer termed and harder to treat) does not set in.




Causes

A lot of stress on the feet is the cause of Achilles tendinitis. It is a common athletic injury. Things that can cause tendinitis include, pushing your body too fast and too soon, sudden increase in activity, sports that cause you to quickly start and stop, poor fitting shoes, bad footwear, severe injury to the Achilles tendon, running or exercising on uneven ground, running uphill, tight calf muscles, bone spur (extra bone growth in heel that rubs the tendon and causes pain), flat arches, feet that roll in (overpronation), and weak calf muscles, not warming up before exercising.




Symptoms

Gradual onset of pain and stiffness over the tendon, which may improve with heat or walking and worsen with strenuous activity. Tenderness of the tendon on palpation. There may also be crepitus and swelling. Pain on active movement of the ankle joint. Ultrasound or MRI may be necessary to differentiate tendonitis from a partial tendon rupture.




Diagnosis

There is enlargement and warmth of the tendon 1 to 4 inches above its heel insertion. Pain and sometimes a scratching feeling may be created by gently squeezing the tendon between the thumb and forefinger during ankle motion. There may be weakness in push-off strength with walking. Magnetic resonance imaging (MRI) can define the extent of degeneration, the degree to which the tendon sheath is involved and the presence of other problems in this area, but the diagnosis is mostly clinical.




Nonsurgical Treatment

Treatment will focus on relieving the pain and preventing further injury. Your podiatrist may create shoe inserts or a soft cast to effectively immobilize the affected area for a period of time. (Often, a couple of weeks are needed for the tendon to heal.) Medication can help too. Your podiatrist may recommend or prescribe oral medication.

Achilles Tendon




Surgical Treatment

Surgery can be done to remove hardened fibrous tissue and repair any small tendon tears as a result of repetitive use injuries. This approach can also be used to help prevent an Achilles tendon rupture. If your Achilles tendon has already ruptured or torn, Achilles tendon surgery can be used to reattach the ends of the torn tendon. This approach is more thorough and definitive compared to non surgical treatment options discussed above. Surgical reattachment of the tendon also minimizes the change of re-rupturing the Achilles tendon.




Prevention

The following measures can significantly reduce the risk of developing Achilles tendonitis. Adequately stretch and warm up prior to exercise. Warm down and stretch after exercise. Choose footwear carefully and use footwear appropriate to the sport being undertaken. Use orthotic devices in footwear to correctly support the foot. Exercise within fitness levels and follow a sensible exercise programme. Develop strong, flexible calf muscles.