All About Achilles Tendinitis

Overview

Achilles TendonitisThe Achilles tendon is the largest and strongest tendon in the human body. It is the ?cord? in the back of the leg that inserts into the back of the heel. The Achilles tendon got its name, according to Greek legend, when the Greek warrior, Achilles, was dipped into the River Styx by Thetis, his mother. This rendered him invincible with the exception of his unsubmerged heel. Unfortunately, he went on to get mortally wounded during the siege of Troy when he was struck in that heel by an arrow. Achilles tendinitis is inflammation and partial tearing of the Achilles tendon. It can occur with overuse of the tendon such as when starting or increasing the intensity of an exercise program or performing impact loading activities that include a lot of running and/or jumping.

Causes

Achilles tendinitis is usually caused by straining the Achilles tendon through intense activity or a sudden increase in exercise. Individuals who play basketball often develop Achilles tendinitis as a result of pivoting, jumping, and running. These repetitive movements put pressure on the tendon and can gradually wear it down over time. Increasing the intensity of your workouts may also lead to the development of Achilles tendinitis. This is commonly seen in long distance runners who do quite a bit of uphill running. Similarly, if you start exercising more frequently you may also develop the condition due to overuse of the tendon. Not stretching properly before exercise can also make the tendon more prone to injury. Achilles tendinitis is also common in individuals whose feet have a flattened arch, as this places more stress on the tendon. The condition can also be triggered by arthritis, as joint pain can cause one to compensate by putting more pressure on the Achilles tendon.

Symptoms

Recurring localized pain, sometimes severe, along the tendon during or a few hours after running. Morning tenderness about an inch and a half above the point where the Achilles tendon is attached to the heel bone. Sluggishness in your leg. Mild or severe swelling. Stiffness that generally diminishes as the tendon warms up with use.

Diagnosis

The doctor will perform a physical exam. The doctor will look for tenderness along the tendon and pain in the area of the tendon when you stand on your toes. X-rays can help diagnose bone problems. An MRI scan may be done if your doctor is thinking about surgery or is worried about the tear in the Achilles tendon.

Nonsurgical Treatment

Tendinitis usually responds well to self-care measures. But if your signs and symptoms are severe or persistent, your doctor might suggest other treatment options. If over-the-counter pain medications - such as ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve) - aren't enough, your doctor might prescribe stronger medications to reduce inflammation and relieve pain. A physical therapist might suggest some of the following treatment options. Exercises. Therapists often prescribe specific stretching and strengthening exercises to promote healing and strengthening of the Achilles tendon and its supporting structures. Orthotic devices. A shoe insert or wedge that slightly elevates your heel can relieve strain on the tendon and provide a cushion that lessens the amount of force exerted on your Achilles tendon.

Achilles Tendonitis

Surgical Treatment

Chronic Achilles tendon tears can be more complicated to repair. A tendon that has torn and retracted (pulled back) into the leg will scar in the shortened position over time. Restoring normal tendon length is usually not an issue when surgery is performed within a few weeks of the injury. However, when there has been a delay of months or longer, the treatment can be more complicated. Several procedures can be used to add length to a chronic Achilles tear. A turndown procedure uses tissue folded down from the top of the calf to add length to the Achilles tendon. Tendon transfers from other tendons of the ankle can also be performed to help restore function of the Achilles. The results of surgery in a chronic situation are seldom as good as an acute repair. However, in some patients, these procedures can help restore function of a chronically damaged Achilles.

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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