Achilles tendinitis is a
common condition that causes pain along the back of the leg near the heel. The Achilles tendon is the largest tendon in the body. It connects your calf muscles to your heel bone and is used when you
walk, run, and jump. Although the Achilles tendon can withstand great stresses from running and jumping, it is also prone to tendinitis, a condition associated with overuse and degeneration. Simply
defined, tendinitis is inflammation of a tendon. Inflammation is the body's natural response to injury or disease, and often causes swelling, pain, or irritation. There are two types of Achilles
tendinitis, based upon which part of the tendon is inflamed. Noninsertional Achilles tendinitis, Noninsertional Achilles Tendinitis. In noninsertional In both noninsertional and insertional Achilles
tendinitis, damaged tendon fibers may also calcify (harden). Tendinitis that affects the insertion of the tendon can occur at any time, even in patients who are not 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.
There will be a gradual onset of achilles tendon pain over a period of weeks, or even months. The pain will come on during exercise and is constant throughout the training session. Pain will be felt
in the achilles tendon when walking especially up hill or up stairs. This is because the achilles is having to stretch further than normal. There is likely to be stiffness in the Achilles tendon
especially in the morning or after a long period of rest. This is thought to be due to adhesions between the tendon sheath and the tendon itself. Nodules or lumps may be found in the achilles tendon,
particularly 2-4cm above the heel and the skin will appear red. Pain and tenderness will be felt when pressing in on the achilles tendon which is likely to appear thickened or swollen. A creaking
sensation may be felt when press the fingers into the sides of the tendon and moving the ankle.This is known as crepitus.
Confirming Achilles tendonitis may involve imaging tests. X-rays provide images of the bones of the foot and leg. Magnetic resonance imaging (MRI) is useful for detecting ruptures and degeneration of
tissue. Ultrasound shows tendon movement, related damage, and inflammation.
Initial treatment of mild Achilles tendinitis involves rest, stretching exercises, and non-prescriptive medications to relieve pain and reduce inflammation. These medications include nonsteroidal
anti-inflammatory drugs (NSAID) such as ibuprofen or naproxen. Relief of pain and swelling may be achieved with the application of ice for15 minutes at a time. Sleeping with the affected foot propped
up on a pillow may also relieve swelling. Adequate time must be given to rest and recovery, meaning months or weeks, to prevent re-injury of the Achilles tendon. Most people make a full recovery and
are able to return to their regular sports and exercise programs.
Around 1 in 4 people who have persisting pain due to Achilles tendinopathy has surgery to treat the condition. Most people have a good result from surgery and their pain is relieved. Surgery involves
either of the following, removing nodules or adhesions (parts of the fibres of the tendon that have stuck together) that have developed within the damaged tendon. Making a lengthways cut in the
tendon to help to stimulate and encourage tendon healing. Complications from surgery are not common but, if they do occur, can include problems with wound healing.
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.