What Causes Achilles Tendonitis ?

Overview

Achilles TendonitisThe Achilles tendon is the largest tendon in the body. It is formed by the merging together of the upper calf muscles and inserts into the back of the heel bone. Its blood supply comes from the muscles above and the bony attachment below. The blood supply is limited at the ?watershed? zone approximately 1 to 4 inches above the insertion into the heel bone. Paratendonitis and tendinosis develop in the same area. Achilles tendinitis implies an inflammatory response, but this is very limited because there is little blood supply to the Achilles tendon. More appropriate descriptions are inflammation of the surrounding sheath (paratenonitis), degeneration within the substance of the tendon (tendinosis) or a combination of the two.

Causes

Achilles tendonitis most commonly occurs due to repetitive or prolonged activities placing strain on the Achilles tendon. This typically occurs due to excessive walking, running or jumping activities. Occasionally, it may occur suddenly due to a high force going through the Achilles tendon beyond what it can withstand. This may be due to a sudden acceleration or forceful jump. The condition may also occur following a calf or Achilles tear, following a poorly rehabilitated sprained ankle or in patients with poor foot biomechanics or inappropriate footwear. In athletes, this condition is commonly seen in running sports such as marathon, triathlon, football and athletics.

Symptoms

Symptoms of Achilles tendonitis include, pain in the back of the heel, difficulty walking, sometimes the pain makes walking impossible, swelling, tenderness and warmth of the Achilles tendon. Achilles tendonitis is graded according to how severe it is, mild - pain in the Achilles tendon during a particular activity (such as running) or shortly after. Moderate - the Achilles tendon may swell. In some cases, a hard lump (nodule) may form in the tendon. Severe - any type of activity that involves weight bearing causes pain of the Achilles tendon. Very occasionally, the Achilles tendon may rupture (tear). When an Achilles tendon ruptures, it is said to feel like a hard whack on the heel.

Diagnosis

To diagnose the condition correctly, your doctor will ask you a few questions about the pain and swelling in your heel. You may be asked to stand on the balls of your feet while your doctor observes your range of motion and flexibility. The doctor may also touch the area directly. This allows him to pinpoint where the pain and swelling is most severe.

Nonsurgical Treatment

Massage therapy improves blood flow to the muscles and tissues of the affected area while increasing range of motion and can prevent recurring injury. The healing process can be quickened using ultrasound heat therapy to improve blood flow to the affected area. Wearing a night brace keeps the leg flexed, preventing stiffening of the tendon, which would impair healing. Stretching exercises increase flexibility and allow the tendon to heal without shortening, a deformity resulting in chronic pain. Persistent Achilles pain may warrant the use of a cast or walking boot to be worn for 4-6 weeks stabilizing the tendon so it can heal. After removal of the cast or boot, physical therapy will be ordered to increase functionality of the affected limb. To reduce chronic inflammation of the tendon, corticosteroid injections may be prescribed. It?s important to note that this corticosteroid treatment increases the risk of tendon rupture. Ultrasound imaging may be used by the physician administering the steroid injection, in order to help visualize the affected area. When all other therapies have failed to or tendon rupture occurs, surgical intervention and repair of the muscles and tendons is the last treatment option.

Achilles Tendinitis

Surgical Treatment

The type of surgery you will have depends on the type of injury you are faced with. The longer you have waited to have surgery will also be a factor that determines what type of surgery is needed. With acute (recent) tearing the separation in your Achilles tendon is likely to be very minimal. If you have an acute tear you may qualify for less invasive surgery (such as a mini-open procedure). Surgeons will always choose a shorter, less invasive procedure if it is possible to do so. Most surgeons know that a less complicated procedure will have less trauma to the tendon and a much quicker rate of recovery after the surgery.

Prevention

Do strengthening and stretching exercises to keep calf muscles strong and flexible. Keep your hamstring muscles flexible by stretching. Warm up and stretch adequately before participating in any sports. Always increase the intensity and duration of training gradually. Do not continue an exercise if you experience pain over the tendon. Wear properly fitted running and other sports shoes, including properly fitted arch supports if your feet roll inwards excessively (over-pronate).

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