Achilles Tendonitis

Overview

Achilles TendonYou can feel your Achilles tendon beneath the skin on the back of your ankle. It is a fibrous band of tissue that connects your calf muscles to your heel bone (calcaneus), which allows you to lift your heel off the ground. Most commonly an overuse injury, the term Achilles tendinitis commonly refers to, acute inflammation in the sheath surrounding your tendon, chronic damage to the tendon itself, called tendinosis, a combination of the two. Achilles tendinitis can range from mild inflammation to, in rare cases, a tendon rupture. One type of tendinitis, called insertional Achilles tendinitis, can affect the end of the tendon where it attaches to your heel bone. Achilles tendinitis also can be associated with other foot problems, such as painful flat feet.




Causes

The majority of Achilles tendon injuries are due to overuse injuries. Other factors that lead to Achilles tendonitis are improper shoe selection, inadequate stretching prior to engaging in athletics, a short Achilles tendon, direct trauma (injury) to the tendon, training errors and heel bone deformity. There is significant evidence that people with feet that role in excessively (over-pronate) are at greater risk for developing Achilles tendinitis. The increased pronation puts additional stress on the tendon, therefore, placing it at greater risk for injury.




Symptoms

In most cases, symptoms of Achilles tendonitis, also sometimes called Achilles tendinitis, develop gradually. Pain may be mild at first and worsen with continued activity. Repeated or continued stress on the Achilles tendon increases inflammation and may cause it to rupture. Partial or complete rupture results in traumatic damage and severe pain, making walking virtually impossible and requiring a long recovery period. Patients with tendinosis may experience a sensation of fullness in the back of the lower leg or develop a hard knot of tissue (nodule).




Diagnosis

During the physical exam, your doctor will gently press on the affected area to determine the location of pain, tenderness or swelling. He or she will also evaluate the flexibility, alignment, range of motion and reflexes of your foot and ankle. Your doctor may order one or more of the following tests to assess your condition, X-rays. While X-rays can't visualize soft tissues such as tendons, they may help rule out other conditions that can cause similar symptoms. Ultrasound. This device uses sound waves to visualize soft tissues like tendons. Ultrasound can also produce real-time images of the Achilles tendon in motion. Magnetic resonance imaging (MRI). Using radio waves and a very strong magnet, MRI machines can produce very detailed images of the Achilles tendon.




Nonsurgical Treatment

There are a variety of treatments for Achilles tendonitis. These range from rest and aspirin to steroid injections and surgery. Your doctor might suggest, reducing your physical activity, stretching and strengthening the calf muscles, switching to a different, less strenuous sport, icing the area after exercise or when in pain, raising your foot to decrease swelling, wearing a brace or compressive elastic bandage to prevent heel movement, undergoing physical therapy, taking anti-inflammatory medication (e.g., aspirin or ibuprofen) for a limited time, getting steroid injections, Sometimes more conservative treatments are not effective. In these cases, surgery may be necessary to repair the Achilles tendon. If the condition intensifies and is left untreated, there?s a greater risk of an Achilles rupture. This can cause sharp pain in the heel area.

Achilles Tendonitis




Surgical Treatment

Surgery for an acute Achilles tendon tear is seemingly straightforward. The ends of the torn tendon are surgically exposed and sutures are used to tie the ends together. The sutures used to tie together the torn tendon ends are thick and strong, and are woven into the Achilles both above and below the tear. While the concepts of surgery are straightforward, the execution is more complex. Care must be taken to ensure the tendon is repaired with the proper tension -- not too tight or too loose. The skin must be taken care of, as excessive handling of the soft tissues can cause severe problems including infection and skin necrosis. Nerves are located just adjacent to the tendon, and must be protected to prevent nerve injury. If surgery is decided upon, it is usually performed within days or weeks of the injury. The idea is to perform the repair before scar tissue has formed, which would make the repair more difficult. Some surgeons may recommend delaying surgery a few days from the initial injury to allow swelling to subside before proceeding with the repair.




Prevention

Although Achilles tendinitis cannot be completely prevented, the risk of developing it can be lowered. Being aware of the possible causes does help, but the risk can be greatly reduced by taking the following precautions. Getting a variety of exercise - alternating between high-impact exercises (e.g. running) and low-impact exercise (e.g. swimming) can help, as it means there are days when the Achilles tendon is under less tension. Limit certain exercises - doing too much hill running, for example, can put excessive strain on the Achilles tendon. Wearing the correct shoes and replacing them when worn - making sure they support the arch and protect the heel will create less tension in the tendon. Using arch supports inside the shoe, if the shoe is in good condition but doesn't provide the required arch support this is a cheaper (and possibly more effective) alternative to replacing the shoe completely. Stretching, doing this before and after exercising helps to keep the Achilles tendon flexible, which means less chance of tendinitis developing. There is no harm in stretching every day (even on days of rest), as this will only further improve flexibility. Gradually increasing the intensity of a workout - Achilles tendinitis can occur when the tendon is suddenly put under too much strain, warming up and increasing the level of activity gradually gives your muscles time to loosen up and puts less pressure on the tendon.

Write a comment

Comments: 0