Achilles Tendinitis is a painful condition. Running and walking are made possible by the Achilles tendon, which attaches the calf muscle to the heel bone. Strenuous exercise, jumping, and climbing are all movements that can strain the tendon and calf muscles, causing an inflammation known as tendinitis. The injury to the Achilles can be mild, requiring only rest and over-the-counter anti-inflammatory drugs, or severe, necessitating surgical repair of the damaged tendon. Chronic Achilles tendinitis can lead to micro tears in the tissue (tendinosis), which weaken the tendon and put it at risk for severe damage such as a tear or rupture.
Achilles tendinitis may be caused by intensive hill running, sprinting, or stair climbing. Overuse resulting from the natural lack of flexibility in the calf muscles. Rapidly increasing intensity of exercise, especially after a period of inactivity. Sudden and hard contraction of the calf muscles when exerting extra effort, like that in a final sprint or high jump.
Paratenonitis presents in younger people. Symptoms start gradually and spontaneously. Aching and burning pain is noted especially with morning activity. It may improve slightly with initial activity, but becomes worse with further activity. It is aggravated by exercise. Over time less exercise is required to cause the pain. The Achilles tendon is often enlarged, warm and tender approximately 1 to 4 inches above its heel insertion. Sometimes friction is noted with gentle palpation of the tendon during ankle motion. Tendinosis presents similarly but typically in middle-aged people. If severe pain and limited walking ability are present, it may indicate a partial tear of the tendon.
There is enlargement and warmth of the tendon 1 to 4 inches above its heel insertion. Pain and sometimes a scratching feeling may be created by gently squeezing the tendon between the thumb and forefinger during ankle motion. There may be weakness in push-off strength with walking. Magnetic resonance imaging (MRI) can define the extent of degeneration, the degree to which the tendon sheath is involved and the presence of other problems in this area, but the diagnosis is mostly clinical.
The latest studies on Achilles tendonitis recommend a treatment plan that incorporates the following three components. Treatment of the inflammation. Strengthening of the muscles that make up the Achilles tendon using eccentric exercise. These are a very specific type of exercise that has been shown in multiple studies to be a critical component of recovering from Achilles tendonitis. Biomechanical control (the use of orthotics and proper shoes). Shockwave therapy.
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.
Regardless of whether the Achilles injury is insertional or non-insertional, a great method for lessening stress on the Achilles tendon is flexor digitorum longus exercises. This muscle, which originates along the back of the leg and attaches to the tips of the toes, lies deep to the Achilles. It works synergistically with the soleus muscle to decelerate the forward motion of the leg before the heel leaves the ground during propulsion. This significantly lessens strain on the Achilles tendon as it decelerates elongation of the tendon. Many foot surgeons are aware of the connection between flexor digitorum longus and the Achilles tendon-surgical lengthening of the Achilles (which is done to treat certain congenital problems) almost always results in developing hammer toes as flexor digitorum longus attempts to do the job of the recently lengthened tendon. Finally, avoid having cortisone injected into either the bursa or tendon-doing so weakens the tendon as it shifts production of collagen from type one to type three. In a recent study published in the Journal of Bone Joint Surgery(9), cortisone was shown to lower the stress necessary to rupture the Achilles tendon, and was particularly dangerous when done on both sides, as it produced a systemic effect that further weakened the tendon.