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.
Tendons are the tough fibres that connect muscle to bone. Most tendon injuries occur near joints, such as the shoulder, elbow, knee, and ankle. A tendon injury may seem to happen suddenly, but
usually it is the result of many tiny tears to the tendon that have happened over time. Health professionals may use different terms to describe a tendon injury. You may hear, Tendonitis (or
Tendinitis): This actually means "inflammation of the tendon," but inflammation is rarely the cause of your tendon pain.
Achilles tendonitis and tendinopathy present as pain in the Achilles tendon, usually several centimeters above where it inserts on the heel. In some patients, pain and tendon damage are primarily at
the insertion to the heel bone. There may be swelling and/or thickening of the tendon. Bending at the ankle, walking, jumping, and running are often painful with this condition.
A podiatrist can usually make the diagnosis by clinical history and physical examination alone. Pain with touching or stretching the tendon is typical. There may also be a visible swelling to the
tendon. The patient frequently has difficulty plantarflexing (pushing down the ball of the foot and toes, like one would press on a gas pedal), particularly against resistance. In most cases X-rays
don't show much, as they tend to show bone more than soft tissues. But X-rays may show associated degeneration of the heel bone that is common with Achilles Tendon problems. For example, heel spurs,
calcification within the tendon, avulsion fractures, periostitis (a bruising of the outer covering of the bone) may all be seen on X-ray. In cases where we are uncertain as to the extent of the
damage to the tendon, though, an MRI scan may be necessary, which images the soft tissues better than X-rays. When the tendon is simply inflamed and not severely damaged, the problem may or may not
be visible on MRI. It depends upon the severity of the condition.
The main treatments for Achilles tendinitis do not involve surgery. It is important to remember that it may take at least 2 to 3 months for the pain to go away. Try putting ice over the Achilles
tendon for 15 to 20 minutes, two to three times per day. Remove the ice if the area gets numb. Changes in activity may help manage the symptoms. Decrease or stop any activity that causes you pain.
Run or walk on smoother and softer surfaces. Switch to biking, swimming, or other activities that put less stress on the Achilles tendon. Your health care provider or physical therapist can show you
stretching exercises for the Achilles tendon. They may also suggest the following changes in your footwear, a brace or boot or cast to keep the heel and tendon still and allow the swelling to go
down, heel lifts placed in the shoe under the heel, shoes that are softer in the areas over and under the heel cushion. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen can
help with pain or swelling. Talk with your health care provider. If these treatments do not improve symptoms, you may need surgery to remove inflamed tissue and abnormal areas of the tendon. Surgery
also can be used to remove the bone spur that is irritating the tendon. Extracorporeal shock wave therapy (ESWT) may be an alternative to surgery for people who have not responded to other
treatments. This treatment uses low-dose sound waves.
Surgery can be done to remove hardened fibrous tissue and repair any small tendon tears as a result of repetitive use injuries. This approach can also be used to help prevent an Achilles tendon
rupture. If your Achilles tendon has already ruptured or torn, Achilles tendon surgery can be used to reattach the ends of the torn tendon. This approach is more thorough and definitive compared to
non surgical treatment options discussed above. Surgical reattachment of the tendon also minimizes the change of re-rupturing the Achilles tendon.
Stay in good shape year-round and try to keep your muscles as strong as they can be. Strong, flexible muscles work more efficiently and put less stress on your tendon. Increase the intensity and
length of your exercise sessions gradually. This is especially important if you've been inactive for a while or you're new to a sport. Always warm up before you go for a run or play a sport. If your
muscles are tight, your Achilles tendons have to work harder to compensate. Stretch it out. Stretch your legs, especially your calves, hamstrings, quadriceps, and thigh muscles - these muscles help
stabilize your knee while running. Get shoes that fit properly and are designed for your sport. If you're a jogger, go to a running specialty store and have a trained professional help you select
shoes that match your foot type and offer plenty of support. Replace your shoes before they become worn out. Try to run on softer surfaces like grass, dirt trails, or synthetic tracks. Hard surfaces
like concrete or asphalt can put extra pressure on the joints. Also avoid running up or down hills as much as possible. Vary your exercise routine. Work different muscle groups to keep yourself in
good overall shape and keep individual muscles from getting overused. If you notice any symptoms of Achilles tendonitis, stop running or doing activities that put stress on your feet. Wait until all
the pain is gone or you have been cleared to start participating again by a doctor.