Achilles tendinitis is an uncomfortable condition where a person?s large tendon in the back of their ankle becomes irritated and inflamed. It is a very common type of injury, most often seen in recreational athletes. This makes sense because recreational athletes still play hard at their sports, but don?t have the full knowledge or training that comes with being a professional to prevent injuries. Achilles tendon pain is not something to be taken lightly, so if you are aware of your own, you should definitely seek some medical advice.
Sometimes Achilles Tendinitis is a result of sudden trauma, as you might encounter from playing sports, but you can also have Achilles tendon pain as a result of small, unnoticed, day-to-day irritations that inflame the tendon over time by a cumulative effect. In those with no history of trauma, Achilles Tendonitis is sometimes associated simply with long periods of standing. There are several factors that can cause the gradual development of Achilles Tendinitis. Improper shoe selection, particularly using high heels over many years, increases your odds of developing the condition. This is because high-heeled shoes cause your calf muscles to contract, leaving the tendon with a lot less slack in it. Inadequate stretching before engaging in athletic or other physically-demanding activities also predisposes you to develop the problem. This is especially true in “weekend athletes”, individuals who tend to partake in excessive physical activities on an intermittent basis. Biomechanical abnormalities like excessive pronation (too much flattening of the arch) also tends to cause this condition. And it is much more common individuals with equinus. It is more common in the middle-aged, the out-of-shape, smokers, and in those who use steroids. Men get the condition more frequently than women. Those involved in jumping and high-impact sports are particularly vulnerable.
Common symptoms of Achilles tendinitis include, pain and stiffness along the Achilles tendon in the morning, pain along the tendon or back of the heel that worsens with activity, Severe pain the day after exercising, thickening of the tendon, bone spur (insertional tendinitis) swelling that is present all the time and gets worse throughout the day with activity, If you have experienced a sudden “pop” in the back of your calf or heel, you may have ruptured (torn) your Achilles tendon. See your doctor immediately if you think you may have torn your tendon.
If you think you might have Achilles tendonitis, check in with your doctor before it gets any worse. Your doc will ask about the activities you’ve been doing and will examine your leg, foot, ankle, and knee for range of motion. If your pain is more severe, the doctor may also make sure you haven’t ruptured (torn) your Achilles tendon. To check this, the doc might have you lie face down and bend your knee while he or she presses on your calf muscles to see if your foot flexes. Any flexing of the foot means the tendon is at least partly intact. It’s possible that the doctor might also order an X-ray or MRI scan of your foot and leg to check for fractures, partial tears of the tendon, or signs of a condition that might get worse. Foot and ankle pain also might be a sign of other overuse injuries that can cause foot and heel pain, like plantar fasciitis and Sever’s disease. If you also have any problems like these, they also need to be treated.
The recommended treatment for Achilles tendinitis consists of icing, gentle stretching, and modifying or limiting activity. Nonsteroidal anti-inflammatory medications (NSAIDs), such as ibuprofen or naprosyn, can reduce pain and swelling. Physical therapy and the use of an orthosis (heel lift) can also be helpful. For chronic cases where tendinosis is evident and other methods of treatment have failed, surgery may be recommended to remove and repair the damaged tissue.
Surgery should be considered to relieve Achilles tendinitis only if the pain does not improve after 6 months of nonsurgical treatment. The specific type of surgery depends on the location of the tendinitis and the amount of damage to the tendon. Gastrocnemius recession. This is a surgical lengthening of the calf (gastrocnemius) muscles. Because tight calf muscles place increased stress on the Achilles tendon, this procedure is useful for patients who still have difficulty flexing their feet, despite consistent stretching. In gastrocnemius recession, one of the two muscles that make up the calf is lengthened to increase the motion of the ankle. The procedure can be performed with a traditional, open incision or with a smaller incision and an endoscope-an instrument that contains a small camera. Your doctor will discuss the procedure that best meets your needs. Complication rates for gastrocnemius recession are low, but can include nerve damage. Gastrocnemius recession can be performed with or without d?bridement, which is removal of damaged tissue. D?bridement and repair (tendon has less than 50% damage). The goal of this operation is to remove the damaged part of the Achilles tendon. Once the unhealthy portion of the tendon has been removed, the remaining tendon is repaired with sutures, or stitches to complete the repair. In insertional tendinitis, the bone spur is also removed. Repair of the tendon in these instances may require the use of metal or plastic anchors to help hold the Achilles tendon to the heel bone, where it attaches. After d?bridement and repair, most patients are allowed to walk in a removable boot or cast within 2 weeks, although this period depends upon the amount of damage to the tendon. D?bridement with tendon transfer (tendon has greater than 50% damage). In cases where more than 50% of the Achilles tendon is not healthy and requires removal, the remaining portion of the tendon is not strong enough to function alone. To prevent the remaining tendon from rupturing with activity, an Achilles tendon transfer is performed. The tendon that helps the big toe point down is moved to the heel bone to add strength to the damaged tendon. Although this sounds severe, the big toe will still be able to move, and most patients will not notice a change in the way they walk or run. Depending on the extent of damage to the tendon, some patients may not be able to return to competitive sports or running. Recovery. Most patients have good results from surgery. The main factor in surgical recovery is the amount of damage to the tendon. The greater the amount of tendon involved, the longer the recovery period, and the less likely a patient will be able to return to sports activity. Physical therapy is an important part of recovery. Many patients require 12 months of rehabilitation before they are pain-free.
Stretching of the gastrocnemius (keep knee straight) and soleus (keep knee bent) muscles. Hold each stretch for 30 seconds, relax slowly. Repeat stretches 2 – 3 times per day. Remember to stretch well before running strengthening of foot and calf muscles (eg, heel raises) correct shoes, specifically motion-control shoes and orthotics to correct overpronation. Gradual progression of training programme. Avoid excessive hill training. Incorporate rest into training programme.