Achilles tendinitis is an
irritation/inflammation in the achilles tendon, which attaches to the back of the heel. It is often a result of overuse and occurs frequently in runners who have altered their training suddenly,
either with regard to duration or intensity. This injury is also prevalent in middle-aged people who are active.
There are several factors that can contribute to achilles tendonitis. First, you should know that the biggest contributor to chronic achilles tendonitis is ignoring pain in your achilles tendon and
running through the pain of early achilles tendonitis. If your achilles tendon is getting sore it is time to pay attention to it, immediately. Sudden increases in training can contribute to achilles
tendonitis. Excessive hill running or a sudden addition of hills and speed work can also contribute to this problem. Two sole construction flaws can also aggravate achilles tendonitis. The first is a
sole that is too stiff, especially at the ball of the foot. (In case you are having difficulty locating the "ball" of your foot, I mean the part where the toes join the foot and at which the foot
bends) If this area is stiff than the "lever arm" of the foot is longer and the achilles tendon will be under increased tension and the calf muscles must work harder to lift the heel off the ground.
The second contributing shoe design factor which may lead to continuing achilles tendon problem is excessive heel cushioning. Air filled heels, while supposedly are now more resistant to deformation
and leaks are not good for a sore achilles tendon. The reason for this is quite simple. If you are wearing a shoe that is designed to give great heel shock absorption what frequently happens is that
after heel contact, the heel continues to sink lower while the shoe is absorbing the shock. This further stretches the achilles tendon, at a time when the leg and body are moving forward over the
foot. Change your shoes to one without this "feature". Of course another major factor is excessive tightness of the posterior leg muscles, the calf muscles and the hamstrings may contribute to
prolonged achilles tendonitis. Gentle calf stretching should be performed preventatively. During a bout of acute achilles tendonitis, however, overly exuberant stretching should not be
Most cases of Achilles tendonitis start out slowly, with very little pain, and then grow worse over time. Some of the more common symptoms include mild pain or an ache above the heel and in the lower
leg, especially after running or doing other physical activities, pain that gets worse when walking uphill, climbing stairs, or taking part in intense or prolonged exercise, stiffness and tenderness
in the heel, especially in the morning, that gradually goes away, swelling or hard knots of tissue in the Achilles tendon, a creaking or crackling sound when moving the ankle or pressing on the
Achilles tendon, weakness in the affected leg.
Examination of the achilles tendon is inspection for muscle atrophy, swelling, asymmetry, joint effusions and erythema. Atrophy is an important clue to the duration of the tendinopathy and it is
often present with chronic conditions. Swelling, asymmetry and erythema in pathologic tendons are often observed in the examination. Joint effusions are uncommon with tendinopathy and suggest the
possibility of intra-articular pathology. Range of motion testing, strength and flexibility are often limited on the side of the tendinopathy. Palpation tends to elicit well-localized tenderness that
is similar in quality and location to the pain experienced during activity. Physical examinations of the Achilles tendon often reveals palpable nodules and thickening. Anatomic deformities, such as
forefoot and heel varus and excessive pes planus or foot pronation, should receive special attention. These anatomic deformities are often associated with this problem. In case extra research is
wanted, an echography is the first choice of examination when there is a suspicion of tendinosis. Imaging studies are not necessary to diagnose achilles tendonitis, but may be useful with
differential diagnosis. Ultrasound is the imaging modality of first choice as it provides a clear indication of tendon width, changes of water content within the tendon and collagen integrity, as
well as bursal swelling. MRI may be indicated if diagnosis is unclear or symptoms are atypical. MRI may show increased signal within the Achilles.
The aim of the treatment is to reduce strain on the tendon and reduce inflammation. Strain may be reduced by, avoiding or severely limiting activities that may aggravate the condition, such as
running, using shoe inserts (orthoses) to take pressure off the tendon as it heals. In cases of flat or hyperpronated feet, your doctor or podiatrist may recommend long-term use of orthoses.
I8nflammation may be reduced by, applying icepacks for 20 minutes per hour during the acute stage, taking non-steroidal anti-inflammatory drugs, placing the foot in a cast or restrictive ankle-boot
to minimise movement and give the tendon time to heal. This may be recommended in severe cases and used for about eight weeks. Occasionally depot (slowly absorbed) steroid injections may be tried,
particularly for peri-tendinitis, but great care needs to be taken to avoid injecting into the tendon. This should only be done by a specialist doctor. You may also be given specific exercises to
gently stretch the calf muscles once the acute stage of inflammation has settled down. Your doctor or physiotherapist will recommend these exercises when you are on the road to recovery. Recovery is
often slow and will depend on the severity of the condition and how carefully you follow the treatment and care instructions you are given.
Occasionally, conservative management of Achilles tendon conditions fails. This failure is more common in older male patients and those with longstanding symptoms, those who persist in full training
despite symptoms or those who have uncorrected predisposing factors. In these cases, surgery may be indicated. It should be remembered, however, that the rehabilitation program, particularly for
severe Achilles tendon injuries, is a slow, lengthy program. Surgery is only indicated when there is failure to progress in the rehabilitation program. Surgery should not be considered unless at
least six months of appropriate conservative management has failed to lead to improvement.
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.