Achilles Tendinitis Facts

Overview

Achilles TendinitisAchilles tendinitis is a common condition that causes pain along the back of the leg near the heel. The Achilles tendon is the largest tendon in the body. It connects your calf muscles to your heel bone and is used when you walk, run, and jump. Although the Achilles tendon can withstand great stresses from running and jumping, it is also prone to tendinitis, a condition associated with overuse and degeneration. Simply defined, tendinitis is inflammation of a tendon. Inflammation is the body's natural response to injury or disease, and often causes swelling, pain, or irritation. There are two types of Achilles tendinitis, based upon which part of the tendon is inflamed. Noninsertional Achilles tendinitis, Noninsertional Achilles Tendinitis. In noninsertional In both noninsertional and insertional Achilles tendinitis, damaged tendon fibers may also calcify (harden). Tendinitis that affects the insertion of the tendon can occur at any time, even in patients who are not active.




Causes

The Achilles tendon is a strong band of connective tissue that attaches the calf muscle to the heel bone. When the muscle contracts, the tendon transmits the power of this contraction to the heel, producing movement. The Achilles tendon moves through a protective sheath and is made up of thousands of tiny fibres. It is thought that Achilles tendonitis develops when overuse of the tendon causes the tiny fibres that make up the tendon to tear. This causes inflammation, pain and swelling. As the tendon swells it can begin to rub against the sheath surrounding it, irritating the sheath and causing it too to become inflamed and swollen. It has a poor blood supply, which can make it susceptible to injury and can make recovery from injury slow. Factors that can lead to the development of Achilles tendonitis include, tight or weak calf muscles, rapidly increasing the amount or intensity of exercise. Hill climbing or stair climbing exercises. Changes in footwear, particularly changing from wearing high-heeled shoes to wearing flat shoes. Wearing inadequate or inappropriate shoes for the sporting activity being undertaken. Not adequately warming up and stretching prior to exercise. A sudden sharp movement that causes the calf muscles to contract and the stress on the Achilles tendon to be increased. This can cause the tendon fibres to tear.




Symptoms

Patients with an Achilles tendon rupture frequently present with complaints of a sudden snap in the lower calf associated with acute, severe pain. The patient reports feeling like he or she has been shot, kicked, or cut in the back of the leg, which may result in an inability to ambulate further. A patient with Achilles tendon rupture will be unable to stand on his or her toes on the affected side. Tendinosis is often pain free. Typically, the only sign of the condition may be a palpable intratendinous nodule that accompanies the tendon as the ankle is placed through its range of motion (ROM). Patients with paratenonitis typically present with warmth, swelling, and diffuse tenderness localized 2-6 cm proximal to the tendon's insertion. Paratenonitis with tendinosis. This is diagnosed in patients with activity-related pain, as well as swelling of the tendon sheath and tendon nodularity.




Diagnosis

If you think you have Achilles tendinitis, make an appointment to see your doctor. The doctor will ask you questions about your recent activity and look for signs. The foot not flexing when the calf muscle is pressed ( if Achilles ruptures or tears in half). Swelling on the back of the foot. Pain in the back of the foot. Limited range of motion in ankle. An X-ray or MRI scan can check for tendinitis.




Nonsurgical Treatment

Nonsurgical methods include rest and stop doing activities that cause stress to the tendon. Ice the area by applying ice to the tendon for 15 minutes after exercising. Compress the tendon by using an athletic wrap or surgical tape. Elevate your injury. You can reduce swelling by lying down and raising your foot at a level that is above your heart. Stretch your ankles and calf muscles. Take anti-inflammatory medication (e.g.: ibuprofen to reduce swelling). Wear orthotics and running shoes. Take part in physical therapy.

Achilles Tendon




Surgical Treatment

Surgical treatment for tendons that fail to respond to conservative treatment can involve several procedures, all of which are designed to irritate the tendon and initiate a chemically mediated healing response. These procedures range from more simple procedures such as percutaneous tenotomy61 to open procedures and removal of tendon pathology. Percutaneous tenotomy resulted in 75% of patients reporting good or excellent results after 18 months. Open surgery for Achilles tendinopathy has shown that the outcomes are better for those tendons without a focal lesion compared with those with a focal area of tendinopathy.62 At 7 months after surgery, 67% had returned to physical activity, 88% from the no-lesion group and 50% from the group with a focal lesion.




Prevention

Suggestions to reduce your risk of Achilles tendonitis include, icorporate stretching into your warm-up and cool-down routines. Maintaining an adequate level of fitness for your sport. Avoid dramatic increases in sports training. If you experience pain in your Achilles tendon, rest the area. Trying to ?work through? the pain will only make your injury worse. Wear good quality supportive shoes appropriate to your sport. If there is foot deformity or flattening, obtain orthoses. Avoid wearing high heels on a regular basis. Maintaining your foot in a ?tiptoe? position shortens your calf muscles and reduces the flexibility of your Achilles tendon. An inflexible Achilles tendon is more susceptible to injury. Maintain a normal healthy weight.

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