Achilles Tendonitis is an inflammation of the Achilles Tendon. This tendon attaches the muscles in the calf of the leg to the back of our heels. The Achilles Tendon is a long and thick tendon, which moves our foot down, so that the toes point to the ground (plantar flexion). This tendon can become inflamed due to the following causes. Over utilizing it, such as too much running, especially up or down hill. Trauma, such as a kick to the tendon. Shoe or boot pressure, especially at its attachment to the heel, or just above it. There are over 250,000 injuries to the Achilles Tendon annually. In fact, more Than 10% of all running injuries are to the Achilles tendon. Tendonitis may be classified as either acute or chronic. Acute Achilles Tendonitis comes on quickly, usually after a specific activity or event. It is characterized by an overstretching or tearing of some of the small fibers of the tendon, and causes pain or tenderness when walking or running. It can occur at the insertion (near the attachment to the heel bone, or further up the leg, about 4 or 5 inches above the heel. Acute tendonitis can also follow a specific injury, such as a kick to the tendon while playing soccer. Chronic Achilles Tendonitis develops gradually over time. Many times, you can feel an obvious thickening of the tendon that may be tender when squeezed, due to long standing scarring of the tendon. Pain is also present when walking or during other forms of activity, and feels better at rest.
Achilles tendonitis is a common sports injury caused by repeated or intense strain on the tendon. But non-athletes also can get it if they put a lot of stress on their feet. Other things that contribute to Achilles tendonitis include. An increase in activity. Starting a training program after a period of inactivity or adding miles or hills to a jogging regimen are two examples of things that put people at risk for Achilles tendonitis. Sports that require sudden starts and stops; for example, tennis and basketball. A change in footwear, or wearing old or badly fitting shoes. New shoes, worn-out shoes, or the wrong size shoes can cause a person's feet to overcompensate and put stress on the Achilles tendon. Additionally, wearing high heels all the time can cause the tendon and calf muscles to get shorter, and the switch to flat shoes and exercise can put extra strain on the heel. Running up hills. Going uphill forces the Achilles tendon to stretch beyond its normal range. Weak calf muscles, flat arches, "overpronation" (feet that roll in when running), or "oversupination" (feet that roll out when running). Overpronation and oversupination make the lower leg rotate and put a twisting stress on the tendon. Exercising without warming up. Tight calf muscles or muscles that lack flexibility decrease a person's range of motion and put an extra strain on the tendon. Running or exercising on a hard or uneven surface or doing lunges or plyometrics without adequate training. A traumatic injury to the Achilles tendon.
Patients with this condition typically experience pain in the region of the heel and back of the ankle. In less severe cases, patients may only experience an ache or stiffness in the Achilles region that increases with rest (typically at night or first thing in the morning) following activities which place stress on the Achilles tendon. These activities typically include walking or running excessively (especially uphill or on uneven surfaces), jumping, hopping, performing heel raises or performing calf stretches. The pain associated with this condition may also warm up with activity in the initial stages of injury. As the condition progresses, patients may experience symptoms that increase during sport or activity, affecting performance. Pain may also increase when performing a calf stretch or heel raise (i.e. rising up onto tip toes). In severe cases, patients may walk with a limp or be unable to weight bear on the affected leg. Patients with Achilles tendonitis may also experience swelling, tenderness on firmly touching the Achilles tendon, weakness and sometimes palpable thickening of the affected Achilles tendon when compared with the unaffected side.
If Achilles tendonitis is suspected, avoid any exercise or activity that causes the pain. It is advisable to see a doctor promptly so that an accurate diagnosis can be made and appropriate treatment recommended. The doctor will take a full medical history and will ask about the nature and duration of the symptoms. They will perform a physical examination of the affected area. Ultrasound scanning may be used to assess damage to the tendon or surrounding structures. Occasionally MRI (magnetic resonance imaging) may be recommended. The symptoms of Achilles tendonitis are often similar to symptoms of other conditions such as partial Achilles tendon rupture and heel bursitis. This can make diagnosis difficult and a referral to an orthopaedic specialist may be required in order for an accurate diagnosis to be made.
Treatment can range from cold compress and heel pads for minor cases, to physical rehabilitation, anti-inflammatory medicine, ultrasound therapy, and manual therapy. If you are a Michigan resident that suspects they have Achilles Tendinitis, please contact Dr. Young immediately; Achilles Tendinitis, if left untreated, can eventually result in an Achilles Tendon Rupture, which is a serious condition that is a partial or complete tear in the tendon. It can severely hinder walking and can be extremely painful and slow to recover.
Percutaneous Achilles Tendon Surgery. During this procedure the surgeon will make 3 to 4 incisions (approx. 2.5 cm long) on both sides of the Achilles tendon. Small forceps are used to free the tendon sheath (the soft tissue casing around your Achilles tendon) to make room for the surgeon to stitch/suture any tears. Skilled surgeons may perform a percutaneous achilles tendon surgery with ultrasound imaging techniques to allow for blink suturing with stab incisions made by a surgical suture needle. This procedure can be done in 3 different ways depending on the preference and experience of your surgeon. Instead of making several 2.5 cm incisions for this procedure, some surgeons will use guided imaging with an ultrasound to see the Achilles tendon tissue without having to open up your ankle. For this technique, they will use a surgical needle to repeatedly stab your Achilles tendon. These "stab incisions" will allow the surgeon to "blindly" suture your tendon without seeing the actual tissue. As another option - some surgeons will only make 1 to 3 incisions for smaller surgical implements to repair your tendon while relying on imaging ultrasound to see your damaged tissue. During either procedure the use of ultrasound imaging or endoscopic techniques requires a very skilled surgeon.
A 2014 study looked at the effect of using foot orthotics on the Achilles tendon. The researchers found that running with foot orthotics resulted in a significant decrease in Achilles tendon load compared to running without orthotics. This study indicates that foot pain doctor (evasiveanyplace79.exteen.com) orthoses may act to reduce the incidence of chronic Achilles tendon pathologies in runners by reducing stress on the Achilles tendon1. Orthotics seem to reduce load on the Achilles tendon by reducing excessive pronation,
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