Concerning Achilles Tendonitis

Overview

Achilles TendonitisThe Achilles tendon, which connects the calf muscles to the heel bone, can withstand significant pressure from physical activities. Achilles tendinitis is estimated to account for approximately 11 percent of all running injuries, as the Achilles tendon provides the momentum to push off to walk or run. Achilles tendinitis, also called Achilles tendinopathy, results from overuse, injury or disease of the Achilles tendon, which causes the area to become inflamed. There are two types of Achilles tendinitis: Non-insertional Achilles Tendinitis – Fibers that are located in the middle portion of the tendon began to develop small tears that cause swelling and thickening. This type of tendinitis is usually found in younger people who are very active. Insertional Achilles Tendinitis – Develops where the tendon attaches to the heel bone in the lower part of the heel. Extra bone growth also called bone spurs form because of this tendinitis and can affect patients at any time, even if they are not active.


Causes

As ?overuse? disorders, Achilles tendonitis and tendonosis are usually caused by a sudden increase of a repetitive activity involving the Achilles tendon. Such activity puts too much stress on the tendon too quickly, leading to micro-injury of the tendon fibers. Due to this ongoing stress on the tendon, the body is unable to repair the injured tissue. The structure of the tendon is then altered, resulting in continued pain. Achilles4Athletes are at high risk for developing disorders of the Achilles tendon. Achilles tendonitis and tendonosis are also common in individuals whose work puts stress on their ankles and feet, such as laborers, as well as in ?weekend warriors?-those who are less conditioned and participate in athletics only on weekends or infrequently. In addition, people with excessive pronation (flattening of the arch) have a tendency to develop Achilles tendonitis and tendonosis due to the greater demands placed on the tendon when walking. If these individuals wear shoes without adequate stability, their over-pronation could further aggravate the Achilles tendon.


Symptoms

Symptoms can vary from an achy pain and stiffness to the insertion of the Achilles tendon to the heel bone (calcaneus), to a burning that surrounds the whole joint around the inflamed thick tendon. With this condition, the pain is usually worse during and after activity, and the tendon and joint area can become stiffer the following day. This is especially true if your sheets are pushing down on your toes and thereby driving your foot into what is termed plantar flexion (downward flexed foot), as this will shorten the tendon all night.


Diagnosis

Laboratory studies usually are not necessary in evaluating and diagnosing an Achilles tendon rupture or injury, although evaluation may help to rule out some of the other possibilities in the differential diagnosis. Imaging studies. Plain radiography: Radiographs are more useful for ruling out other injuries than for ruling in Achilles tendon ruptures. Ultrasonography: Ultrasonography of the leg and thigh can help to evaluate the possibility of deep venous thrombosis and also can be used to rule out a Baker cyst; in experienced hands, ultrasonography can identify a ruptured Achilles tendon or the signs of tendinosis. Magnetic resonance imaging (MRI): MRI can facilitate definitive diagnosis of a disrupted tendon and can be used to distinguish between paratenonitis, tendinosis, and bursitis.


Nonsurgical Treatment

Achilles tendonitis should never be self-treated because of the potential for permanent damage to the tendon. While you are waiting to see your doctor, however, some patients have found relief from symptoms with the use of Silipos Achilles Heel Guard during the day and a Night Splint at night. A topical pain reliever like BioFreeze Cold Therapy can provide temporary relief of pain. Achilles tendonitis only gets worse with time.

Achilles Tendon


Surgical Treatment

Surgery should be considered to relieve Achilles tendinitis only if the pain does not improve after 6 months of nonsurgical treatment. The specific type of surgery depends on the location of the tendinitis and the amount of damage to the tendon. Gastrocnemius recession. This is a surgical lengthening of the calf (gastrocnemius) muscles. Because tight calf muscles place increased stress on the Achilles tendon, this procedure is useful for patients who still have difficulty flexing their feet, despite consistent stretching. In gastrocnemius recession, one of the two muscles that make up the calf is lengthened to increase the motion of the ankle. The procedure can be performed with a traditional, open incision or with a smaller incision and an endoscope-an instrument that contains a small camera. Your doctor will discuss the procedure that best meets your needs. Complication rates for gastrocnemius recession are low, but can include nerve damage. Gastrocnemius recession can be performed with or without d?bridement, which is removal of damaged tissue. D?bridement and repair (tendon has less than 50% damage). The goal of this operation is to remove the damaged part of the Achilles tendon. Once the unhealthy portion of the tendon has been removed, the remaining tendon is repaired with sutures, or stitches to complete the repair. In insertional tendinitis, the bone spur is also removed. Repair of the tendon in these instances may require the use of metal or plastic anchors to help hold the Achilles tendon to the heel bone, where it attaches. After d?bridement and repair, most patients are allowed to walk in a removable boot or cast within 2 weeks, although this period depends upon the amount of damage to the tendon. D?bridement with tendon transfer (tendon has greater than 50% damage). In cases where more than 50% of the Achilles tendon is not healthy and requires removal, the remaining portion of the tendon is not strong enough to function alone. To prevent the remaining tendon from rupturing with activity, an Achilles tendon transfer is performed. The tendon that helps the big toe point down is moved to the heel bone to add strength to the damaged tendon. Although this sounds severe, the big toe will still be able to move, and most patients will not notice a change in the way they walk or run. Depending on the extent of damage to the tendon, some patients may not be able to return to competitive sports or running. Recovery. Most patients have good results from surgery. The main factor in surgical recovery is the amount of damage to the tendon. The greater the amount of tendon involved, the longer the recovery period, and the less likely a patient will be able to return to sports activity. Physical therapy is an important part of recovery. Many patients require 12 months of rehabilitation before they are pain-free.


Prevention

Stretching of the gastrocnemius (keep knee straight) and soleus (keep knee bent) muscles. Hold each stretch for 30 seconds, relax slowly. Repeat stretches 2 – 3 times per day. Remember to stretch well before running strengthening of foot and calf muscles (eg, heel raises) correct shoes, specifically motion-control shoes and orthotics to correct overpronation. Gradual progression of training programme. Avoid excessive hill training. Incorporate rest into training programme.

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