Achilles tendon is the tendon that attaches the gastrocnemius (calf muscles) to the calcaneus bone (back of the heel). It is important in activities that involve plantar flexion of the ankle (pushing
down with the foot or doing heel raises). The Achilles tendon can get inflamed (tendinitis) or it can degenerate/wear out (tendinopathy) with repetitive activities. Aggravating activities include
running and/or repetitive jumping.
Possible factors leading to the development of Achilles tendonitis include the following. Implementing a new exercise regiment such as running uphill or climbing stairs. Change in exercise routine,
boosting intensity or increasing duration. Shoes worn during exercise lack support, either because the soles are worn out or poor shoe design. Omitting proper warm-up prior to strenuous exercise.
Running on a hard or uneven surface. Deformation in foot such as a flat arch, or any anatomic variation that puts unnecessary strain on the Achilles tendon.
A symptom is something the patient feels and reports, while a sign is something other people, such as a doctor, detect. For example, pain is a symptom, while a rash is a sign. The most typical
symptom of Achilles tendinitis is a gradual buildup of pain that deteriorates with time. With Achilles tendinitis, the Achilles tendon may feel sore a few centimeters above where it meets the heel
bone. Other possible signs and symptoms of Achilles tendinitis are, the Achilles tendon feels sore a few centimeters above where it meets the heel bone, lower leg feels stiff or lower leg feels slow
and weak. Slight pain in the back of the leg that appears after running or exercising, and worsens, pain in the Achilles tendon that occurs while running or a couple of hours afterwards. Greater pain
experienced when running fast (such as sprinting), for a long time (such as cross country), or even when climbing stairs. The Achilles tendon swells or forms a bump or the Achilles tendon creaks when
touched or moved. Please note that these symptoms, and others similar can occur in other conditions, so for an accurate diagnosis, the patient would need to visit their doctor.
During an examination of the foot and ankle, you doctor will look for the following signs, Achilles tendon swelling or thickening. Bone spurs appearing at the lower part of the tendon at the back of
the hell. Pain at the middle or lower area of the Achilles tendon. Limited range of motion of the foot and ankle, and a decreased ability to flex the foot. Your doctor may perform imaging tests, such
as X-rays and MRI scans, to make a diagnosis of Achilles tendinitis. X-rays show images of the bones and can help the physician to determine if the Achilles tendon has become hardened, which
indicated insertional Achilles tendinitis. MRI scans may not be necessary, but they are important guides if you are recommended to have surgical treatment. An MRI can show the severity of the damage
and determine what kind of procedure would be best to address the condition.
With proper care for the area, the pain in the tendon should lessen over three weeks, but it should be noted that the healing of the area continues and doesn't even peak until at least six weeks
following the initial injury. This is due to scar tissue formation, which initially acts like the glue to bond the tissue back together. Scar tissue will continue to form past six weeks in some cases
and as long as a year in severe cases. After 6 months this condition is considered chronic and much more difficult to treat. The initial approach to treating Achilles tendonitis is to support and
protect the tendons by bracing any areas of the tendon that are being pulled on during use. It is important to loosen up the tendon, lessen the pain, and minimize any inflammation.
For paratenonitis, a technique called brisement is an option. Local anesthetic is injected into the space between the tendon and its surrounding sheath to break up scar tissue. This can be beneficial
in earlier stages of the problem 30 to 50 percent of the time, but may need to be repeated two to three times. Surgery consists of cutting out the surrounding thickened and scarred sheath. The tendon
itself is also explored and any split tears within the tendon are repaired. Motion is started almost immediately to prevent repeat scarring of the tendon to the sheath and overlying soft tissue, and
weight-bearing should follow as soon as pain and swelling permit, usually less than one to two weeks. Return to competitive activity takes three to six months. Since tendinosis involves changes in
the substance of the tendon, brisement is of no benefit. Surgery consists of cutting out scar tissue and calcification deposits within the tendon. Abnormal tissue is excised until tissue with normal
appearance appears. The tendon is then repaired with suture. In older patients or when more than 50 percent of the tendon is removed, one of the other tendons at the back of the ankle is transferred
to the heel bone to assist the Achilles tendon with strength as well as provide better blood supply to this area.
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.