(tendinitis), is a painful and often debilitating inflammation of the Achilles tendon than can progress into degeneration which we call Achilles Tendinosis. The Achilles tendon is the largest and
strongest tendon in the body. It is located in the back of the lower leg, attaches to the heel bone (calcaneus), and connects the calf muscles to the heel bone. In most cases, Achilles tendonopathy's
are overuse injuries are more common among athletes and people who train heavily, however it can also occur in people who are less active. Achilles Tendonitis can vary in severity from a mild pain in
the tendon during a particular activity to more severe cases when any form of activity that puts strain on this ligament, even standing or walking, can cause pain.
The Achilles tendon is a strong band of connective tissue that attaches the calf muscle to the heel bone. When the muscle contracts, the tendon transmits the power of this contraction to the heel,
producing movement. The Achilles tendon moves through a protective sheath and is made up of thousands of tiny fibres. It is thought that Achilles tendonitis develops when overuse of the tendon causes
the tiny fibres that make up the tendon to tear. This causes inflammation, pain and swelling. As the tendon swells it can begin to rub against the sheath surrounding it, irritating the sheath and
causing it too to become inflamed and swollen. It has a poor blood supply, which can make it susceptible to injury and can make recovery from injury slow. Factors that can lead to the development of
Achilles tendonitis include, tight or weak calf muscles, rapidly increasing the amount or intensity of exercise. Hill climbing or stair climbing exercises. Changes in footwear, particularly changing
from wearing high-heeled shoes to wearing flat shoes. Wearing inadequate or inappropriate shoes for the sporting activity being undertaken. Not adequately warming up and stretching prior to exercise.
A sudden sharp movement that causes the calf muscles to contract and the stress on the Achilles tendon to be increased. This can cause the tendon fibres to tear.
Achilles tendonitis may be felt as a burning pain at the beginning of activity, which gets less during activity and then worsens following activity. The tendon may feel stiff first thing in the
morning or at the beginning of exercise. Achilles tendonitis usually causes pain, stiffness, and loss of strength in the affected area. The pain may get worse when you use your Achilles tendon. You
may have more pain and stiffness during the night or when you get up in the morning. The area may be tender, red, warm, or swollen if there is inflammation. You may notice a crunchy sound or feeling
when you use the tendon.
On examination, an inflamed or partially torn Achilles tendon is tender when squeezed between the fingers. Complete tears are differentiated by sudden, severe pain and inability to walk on the
extremity. A palpable defect along the course of the tendon. A positive Thompson test (while the patient lies prone on the examination table, the examiner squeezes the calf muscle; this maneuver by
the examiner does not cause the normally expected plantar flexion of the foot).
Treatment for Achilles tendonitis, depends on the severity of the injury. If heel pain, tenderness, swelling, or discomfort in the back of the lower leg occurs, physical activity that produces the
symptoms should be discontinued. If the problem returns or persists, a medical professional should be consulted. If pain develops even with proper stretching and training techniques, the patient
should consult a podiatrist to check for hyperpronation and adequate arch support. The addition of an orthotic may be enough to maintain good arch and foot alignment and eliminate pain. If damage to
the tendon is minor, the injury may respond to a simple course of treatment known as RICE (rest, ice, compression, elevation). Patients are advised to rest the tendon by keeping off their feet as
much as possible, apply ice packs for 20 minutes at a time every hour for a day or two to reduce swelling, compress the ankle and foot with a firmly (not tightly) wrapped elastic bandage and elevate
the foot whenever possible to minimize swelling. A nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen may be used to reduce pain, swelling, and inflammation.
Achilles tendon repair surgery is often used to repair a ruptured or torn Achilles tendon, the strong fibrous cord that connects the two large muscles in the back of your calf to your heel bone.
These muscles (the gastrocnemius and the soleus) create the power needed to push off with your foot or rise up on your toes. Achilles tendon ruptures are quite common. Most happen during recreational
activities that require sudden bursts of muscle power in the legs. Often a torn Achilles tendon can be diagnosed with a physical examination. If swelling is present, the orthopaedist may delay the
Achilles tendon surgery until it subsides.
Although Achilles tendinitis cannot be completely prevented, the risk of developing it can be lowered. Being aware of the possible causes does help, but the risk can be greatly reduced by taking the
following precautions. Getting a variety of exercise - alternating between high-impact exercises (e.g. running) and low-impact exercise (e.g. swimming) can help, as it means there are days when the
Achilles tendon is under less tension. Limit certain exercises - doing too much hill running, for example, can put excessive strain on the Achilles tendon. Wearing the correct shoes and replacing
them when worn - making sure they support the arch and protect the heel will create less tension in the tendon. Using arch supports inside the shoe, if the shoe is in good condition but doesn't
provide the required arch support this is a cheaper (and possibly more effective) alternative to replacing the shoe completely. Stretching, doing this before and after exercising helps to keep the
Achilles tendon flexible, which means less chance of tendinitis developing. There is no harm in stretching every day (even on days of rest), as this will only further improve flexibility. Gradually
increasing the intensity of a workout - Achilles tendinitis can occur when the tendon is suddenly put under too much strain, warming up and increasing the level of activity gradually gives your
muscles time to loosen up and puts less pressure on the tendon.