Achilles Tendonitis or achilles tendinopathy which is probably a more accurate term is an overuse injury causing pain, inflammation and or degeneration of the thick achilles tendon at the back of the ankle. The term achilles tendinopathy is probably a better term to describe the range of conditions that can cause achilles tendon pain. Achilles tendonitis can be either acute or chronic. Acute achilles tendonitis is usually more painful and of recent onset. Chronic achilles tendonitis will have come on gradually and over weeks, not necessarily preventing activity.
When you place a large amount of stress on your Achilles tendon too quickly, it can become inflamed from tiny tears that occur during the activity. Achilles tendonitis is often a result of overtraining, or doing too much too soon. Excessive hill running can contribute to it. Flattening of the arch of your foot can place you at increased risk of developing Achilles tendonitis because of the extra stress placed on your Achilles tendon when walking or running.
Achilles tendonitis typically starts off as a dull stiffness in the tendon, which gradually goes away as the area gets warmed up. It may get worse with faster running, uphill running, or when wearing spikes and other low-heeled running shoes. If you continue to train on it, the tendon will hurt more sharply and more often, eventually impeding your ability even to jog lightly. About two-thirds of Achilles tendonitis cases occur at the ?midpoint? of the tendon, a few inches above the heel. The rest are mostly cases of ?insertional? Achilles tendonitis, which occurs within an inch or so of the heelbone. Insertional Achilles tendonitis tends to be more difficult to get rid of, often because the bursa, a small fluid-filled sac right behind the tendon, can become irritated as well.
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.
Relieving the stress is the first course of action. Treatment involves ice therapy and activity modification to reduce inflamation. Active stretching and strengthening exercises will assist rehabilitation of the gastrocnemius-soleus complex. When placed in a heeled shoe, the patient will immediately notice a difference, compared to flat ground. It is recommended that the patient be fitted with proper shoes & orthotics to control pronation and maintain proper alignment, relieving the stress on the achilles tendon. Tightness in the tendon itself can be helped by an extra heel lift added to the orthotics. The patient can expect a slow recovery over a period of months.
Surgery for an Achilles tendon rupture can be done with a single large incision, which is called open surgery. Or it can be done with several small incisions. This is called percutaneous surgery. The differences in age and activity levels of people who get surgery can make it hard to know if Achilles tendon surgery is effective. The success of your surgery can depend on, your surgeon’s experience. The type of surgery you have. How damaged the tendon is. How soon after rupture the surgery is done. How soon you start your rehab program after surgery. How well you follow your rehab program. Talk to your surgeon about his or her surgical experience. Ask about his or her success rate with the technique that would best treat your condition.
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.