Concerning Achilles Tendonitis

Overview

Achilles Tendonitis Achilles tendinitis (tendonitis) or Achilles tendon inflammation occurs when the Achilles tendon becomes inflamed, as a result, of the Achilles tendon being put under too much strain. The Achilles tendon joins the calf muscles to the heel bone, and is found at the back of a person's lower leg. It is the largest tendon in the body and can endure great force, but is still susceptible to injury. Achilles tendinitis is usually the result of strenuous, high impact exercise, such as running. If ignored, Achilles tendinitis can lead to the tendon tearing or rupturing, and therefore it is important to seek the necessary treatment. Sometimes, treatment can be as simple as getting rest or changing an exercise routine. However, in more severe cases, surgery may be required.




Causes

Achilles tendinitis is caused by repetitive or intense strain on the Achilles tendon, the band of tissue that connects your calf muscles to your heel bone. This tendon is used when you walk, run, jump or push up on your toes. The structure of the Achilles tendon weakens with age, which can make it more susceptible to injury - particularly in people who may participate in sports only on the weekends or who have suddenly increased the intensity of their running programs.




Symptoms

The main symptom of Achilles tendonitis is a feeling of pain and swelling in your heel as you walk or run. Other symptoms include tight calf muscles and limited range of motion when flexing the foot. This condition can also make the skin in your heel feel overly warm to the touch.




Diagnosis

The diagnosis is made via discussion with your doctor and physical examination. Typically, imaging studies are not needed to make the diagnosis. However, in some cases, an ultrasound is useful in looking for evidence of degenerative changes in the tendon and to rule out tendon rupture. An MRI can be used for similar purposes, as well. Your physician will determine whether or not further studies are necessary.




Nonsurgical Treatment

Wear shoes with a low half-inch to one-inch heel that are somewhat flexible through the ball of the foot. Avoid flat footwear such as slippers or sandals and stiff shoes. Add a heel lift in your shoe. You may also use arch support inserts or orthotic insoles. Heel lifts and orthotics can be purchased at many of our pharmacies and Podiatry departments. Avoid standing or walking barefoot. Perform calf-stretching exercises for 30 to 60 seconds on each leg at least 2 times a day. Stand an arm?s length away from a wall, facing the wall. Lean into the wall, stepping forward with one leg, leaving the other stretched behind you. The leg behind you is the one being stretched. Keep this leg straight (locked) and the toes pointed straight at the wall. Stretch forward until you feel tightness in the calf of your back leg. Hold this position without bouncing for 30 to 60 seconds. Repeat for the opposite leg. Do stair exercises every day. Stand facing the stairs with the ball of your foot on a stair and your heel hanging off. Balance on one foot at a time while holding onto the rail. Slowly lower your heel as low as it will drop down and then slowly raise it up as high as you can lift it. Repeat this exercise slowly several times on each foot. Perform this exercise every other day, gradually increasing the number of repetitions over time as tolerated. If you are overweight, talk to your personal physician about resources that can help you lose weight. Carrying excess weight places additional pressure on your feet. Decrease the time that you stand, walk, or engage in exercises that put a load on your feet. Switch to a nonimpact form of exercise until your tendon heals, such as swimming, pool running, and using an elliptical trainer.

Achilles Tendon




Surgical Treatment

Surgery can be done to remove hardened fibrous tissue and repair any small tendon tears as a result of repetitive use injuries. This approach can also be used to help prevent an Achilles tendon rupture. If your Achilles tendon has already ruptured or torn, Achilles tendon surgery can be used to reattach the ends of the torn tendon. This approach is more thorough and definitive compared to non surgical treatment options discussed above. Surgical reattachment of the tendon also minimizes the change of re-rupturing the Achilles tendon.




Prevention

Wear shoes that fit correctly and support your feet: Replace your running or exercise shoes before the padding or shock absorption wears out. Shock absorption greatly decreases as the treads on the bottoms or sides of your shoes begin to wear down. You may need running shoes that give your foot more heel or arch support. You may need shoe inserts to keep your foot from rolling inward. Stretch before you exercise: Always warm up your muscles and stretch gently before you exercise. Do cool down exercises when you are finished. This will loosen your muscles and decrease stress on your Achilles tendon. Exercise the right way: If your tendinitis is caused by the way that you exercise, ask a trainer, coach, or your caregiver for help. They can teach you ways to train or exercise to help prevent Achilles tendinitis. Do not run or exercise on uneven or hard surfaces. Instead, run on softer surfaces such as treadmills, rubber tracks, grass, or evenly packed dirt tracks.

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