Regarding Achilles Tendinitis
Overview
The Achilles tendon is the largest tendon in the body. Tendons are long, tough cords of tissue that connect muscle to bone. The Achilles tendon is located in the back of the foot and connects your heel bone to your calf muscle. It helps you to walk, run and jump. The Achilles tendon is able to endure stress, but sometimes injury can occur to the tendon when overly stressed. Overuse of the Achilles tendon may cause the tendon to swell, become irritated, inflamed and cause pain. This is Achilles tendinitis. It is a common sports injury related to running, but can happen to anyone who puts a lot of stress on their feet (e.g.: basketball players and dancers). If you do not get treatment for Achilles tendinitis, the problem can become chronic and make it difficult for you to walk.
Causes
Over-pronation, injury and overstresses of the tendon are some of the most common causes. Risk factors include tight heel cords, poor foot alignment, and recent changes in activities or shoes. During a normal gait cycle, the upper and lower leg rotate in unison (i.e. internally during pronation and externally during supination). However, when a person over-pronates, the lower leg is locked into the foot and therefore continues to rotate internally past the end of the contact phase while the femur begins to rotate externally at the beginning of midstance. The Gastrocnemius muscle is attached to the upper leg and rotates externally while the Soleus muscle is attached to the lower leg and rotates internally during pronation. The resulting counter rotation of the upper and lower leg causes a shearing force to occur in the Achilles tendon. This counter rotation twists the tendon at its weakest area, namely the Achilles tendon itself, and causes the inflammation. Since the tendon is avascular, once inflammation sets in, it tends to be chronic.
Symptoms
Morning pain is a hallmark symptom because the achilles tendon must tolerate full range of movement including stretch immediately on rising in the morning. Symptoms are typically localized to the tendon and immediate surrounding area. Swelling and pain at the attachment are less common. The tendon can appear to have subtle changes in outline, becoming thicker in the A-P and M-L planes. With people who have a tendinopathy of the achilles tendon that has a sensitive zone, combined with intratendinous swelling, that moves along with the tendon and of which sensitivity increases or decreases when the tendon is put under pressure, there will be a high predictive value that in this situation there is a case of tendinosis.
Diagnosis
X-rays are usually normal in patients with Achilles tendonitis, but are performed to evaluate for other possible conditions. Occasionally, an MRI is needed to evaluate a patient for tears within the tendon. If there is a thought of surgical treatment an MRI may be helpful for preoperative evaluation and planning.
Nonsurgical Treatment
NSAIDs help decrease swelling and pain or fever. This medicine is available with or without a doctor's order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, always ask your healthcare provider if NSAIDs are safe for you. Always read the medicine label and follow directions. Steroid injections. Steroids decrease pain and swelling. After you get this shot, you may feel like your Achilles tendon is healed. Do not return to your regular exercise until your caregiver says it is okay. You could make the tendinitis worse, or even tear the tendon. Surgery. If your tendinitis does not heal with other treatments, you may need surgery. Surgery may be done to repair a tear in the tendon, or to remove parts of the tendon. The most important way to manage Achilles tendinitis is to rest. Rest decreases swelling and keeps your tendinitis from getting worse. You may feel pain when you begin to run or exercise. The pain usually goes away as your muscles warm up, but it may come back. Your caregiver may tell you to stop your usual training or exercise activities. He may give you other exercises to do until your Achilles tendon heals. Ice decreases swelling and pain. Put ice in a plastic bag. Cover it with a towel. Put this on your Achilles tendon for 15 to 20 minutes, 3 to 4 times each day. Do this for 2 to 3 days or until the pain goes away. After 2 or 3 days, you may use heat to decrease pain and stiffness. Use a hot water bottle, heating pad, whirlpool, or warm compress. To make a compress, soak a clean washcloth in warm water. Wring out the extra water and put it on your Achilles tendon 15 to 20 minutes, 3 to 4 times each day. Stretching and making the muscles stronger may help decrease stress on your Achilles tendon. Physical therapists can teach you exercises and treatments to help your tendinitis heal faster. You may need to wear inserts in your shoes. You may need to wrap tape around your heel and back of the leg. You may need to wear a cast, brace, or support boot.
Surgical Treatment
Most people will improve with simple measures or physiotherapy. A small number continue to have major problems which interfere with their lifestyle. In this situation an operation may be considered. If an operation is being considered, the surgeon will interview you and examine you again and may want you to have further treatment before making a decision about an operation. Before undergoing Achilles tendonitis surgery, London based patients, and those who can travel, will be advised to undergo a scan, which will reveal whether there is a problem in the tendon which can be corrected by surgery. Patients will also have the opportunity to ask any questions and raise any concerns that they may have, so that they can proceed with the treatment with peace of mind.
Prevention
Appropriately warm up and stretch before practice or competition. Allow time for adequate rest and recovery between practices and competition. Maintain appropriate conditioning, Ankle and leg flexibility, Muscle strength and endurance, Cardiovascular fitness. Use proper technique. To help prevent recurrence, taping, protective strapping, or an adhesive bandage may be recommended for several weeks after healing is complete.
The Achilles tendon is the largest tendon in the body. Tendons are long, tough cords of tissue that connect muscle to bone. The Achilles tendon is located in the back of the foot and connects your heel bone to your calf muscle. It helps you to walk, run and jump. The Achilles tendon is able to endure stress, but sometimes injury can occur to the tendon when overly stressed. Overuse of the Achilles tendon may cause the tendon to swell, become irritated, inflamed and cause pain. This is Achilles tendinitis. It is a common sports injury related to running, but can happen to anyone who puts a lot of stress on their feet (e.g.: basketball players and dancers). If you do not get treatment for Achilles tendinitis, the problem can become chronic and make it difficult for you to walk.
Causes
Over-pronation, injury and overstresses of the tendon are some of the most common causes. Risk factors include tight heel cords, poor foot alignment, and recent changes in activities or shoes. During a normal gait cycle, the upper and lower leg rotate in unison (i.e. internally during pronation and externally during supination). However, when a person over-pronates, the lower leg is locked into the foot and therefore continues to rotate internally past the end of the contact phase while the femur begins to rotate externally at the beginning of midstance. The Gastrocnemius muscle is attached to the upper leg and rotates externally while the Soleus muscle is attached to the lower leg and rotates internally during pronation. The resulting counter rotation of the upper and lower leg causes a shearing force to occur in the Achilles tendon. This counter rotation twists the tendon at its weakest area, namely the Achilles tendon itself, and causes the inflammation. Since the tendon is avascular, once inflammation sets in, it tends to be chronic.
Symptoms
Morning pain is a hallmark symptom because the achilles tendon must tolerate full range of movement including stretch immediately on rising in the morning. Symptoms are typically localized to the tendon and immediate surrounding area. Swelling and pain at the attachment are less common. The tendon can appear to have subtle changes in outline, becoming thicker in the A-P and M-L planes. With people who have a tendinopathy of the achilles tendon that has a sensitive zone, combined with intratendinous swelling, that moves along with the tendon and of which sensitivity increases or decreases when the tendon is put under pressure, there will be a high predictive value that in this situation there is a case of tendinosis.
Diagnosis
X-rays are usually normal in patients with Achilles tendonitis, but are performed to evaluate for other possible conditions. Occasionally, an MRI is needed to evaluate a patient for tears within the tendon. If there is a thought of surgical treatment an MRI may be helpful for preoperative evaluation and planning.
Nonsurgical Treatment
NSAIDs help decrease swelling and pain or fever. This medicine is available with or without a doctor's order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, always ask your healthcare provider if NSAIDs are safe for you. Always read the medicine label and follow directions. Steroid injections. Steroids decrease pain and swelling. After you get this shot, you may feel like your Achilles tendon is healed. Do not return to your regular exercise until your caregiver says it is okay. You could make the tendinitis worse, or even tear the tendon. Surgery. If your tendinitis does not heal with other treatments, you may need surgery. Surgery may be done to repair a tear in the tendon, or to remove parts of the tendon. The most important way to manage Achilles tendinitis is to rest. Rest decreases swelling and keeps your tendinitis from getting worse. You may feel pain when you begin to run or exercise. The pain usually goes away as your muscles warm up, but it may come back. Your caregiver may tell you to stop your usual training or exercise activities. He may give you other exercises to do until your Achilles tendon heals. Ice decreases swelling and pain. Put ice in a plastic bag. Cover it with a towel. Put this on your Achilles tendon for 15 to 20 minutes, 3 to 4 times each day. Do this for 2 to 3 days or until the pain goes away. After 2 or 3 days, you may use heat to decrease pain and stiffness. Use a hot water bottle, heating pad, whirlpool, or warm compress. To make a compress, soak a clean washcloth in warm water. Wring out the extra water and put it on your Achilles tendon 15 to 20 minutes, 3 to 4 times each day. Stretching and making the muscles stronger may help decrease stress on your Achilles tendon. Physical therapists can teach you exercises and treatments to help your tendinitis heal faster. You may need to wear inserts in your shoes. You may need to wrap tape around your heel and back of the leg. You may need to wear a cast, brace, or support boot.
Surgical Treatment
Most people will improve with simple measures or physiotherapy. A small number continue to have major problems which interfere with their lifestyle. In this situation an operation may be considered. If an operation is being considered, the surgeon will interview you and examine you again and may want you to have further treatment before making a decision about an operation. Before undergoing Achilles tendonitis surgery, London based patients, and those who can travel, will be advised to undergo a scan, which will reveal whether there is a problem in the tendon which can be corrected by surgery. Patients will also have the opportunity to ask any questions and raise any concerns that they may have, so that they can proceed with the treatment with peace of mind.
Prevention
Appropriately warm up and stretch before practice or competition. Allow time for adequate rest and recovery between practices and competition. Maintain appropriate conditioning, Ankle and leg flexibility, Muscle strength and endurance, Cardiovascular fitness. Use proper technique. To help prevent recurrence, taping, protective strapping, or an adhesive bandage may be recommended for several weeks after healing is complete.
