Achilles Tendinitis Information
Overview
Achilles tendinitis is an uncomfortable condition where a person?s large tendon in the back of their ankle becomes irritated and inflamed. It is a very common type of injury, most often seen in recreational athletes. This makes sense because recreational athletes still play hard at their sports, but don?t have the full knowledge or training that comes with being a professional to prevent injuries. Achilles tendon pain is not something to be taken lightly, so if you are aware of your own, you should definitely seek some medical advice.
Causes
In some cases, Achilles Tendinitis can be caused by physical activity without a proper warm up or trauma, such as falling, to cause an overstressing of the muscle and tendon. Other causes include repetitive overuse syndrome, such as a job that required frequent heel lifting. Biomechanical causes such as pronation (or fallen arches) will cause the heel (calcaneus) to lean slightly, putting the undue stress on the Achilles tendon and the calf muscles. Most pain can be felt at the back of the heel or the point at which the calf muscle becomes a tendon three quarters of the distance down from the knee. Discomfort can be felt especially when jumping or when lifting the heel off the ground. Swelling and redness can often be seen at the back of the heel and touching the area would cause a tender sensation. In extreme cases, the tendon can become torn or rupture entirely which would cause bruising or an inability to put pressure on the foot.
Symptoms
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.
Diagnosis
There is enlargement and warmth of the tendon 1 to 4 inches above its heel insertion. Pain and sometimes a scratching feeling may be created by gently squeezing the tendon between the thumb and forefinger during ankle motion. There may be weakness in push-off strength with walking. Magnetic resonance imaging (MRI) can define the extent of degeneration, the degree to which the tendon sheath is involved and the presence of other problems in this area, but the diagnosis is mostly clinical.
Nonsurgical Treatment
In order to treat the symptoms, antiflogistics or other anti-inflammatory therapy are often used. However these forms of therapy usually cannot prevent the injury to live on. Nevertheless patients will always have to be encouraged to execute less burdening activities, so that the burden on the tendon decreases as well. Complete immobilisation should however be avoided, since it can cause atrophy. Passive rehabilitation, Mobilisations can be used for dorsiflexion limitation of the talocrural joint and varus- or valgus limitation of the subtalar joint. Deep cross frictions (15 min). It?s effectiveness is not scientifically proven and gives limited results. Recently, the use of Extracorporal Shock Wave Therapy was proven. Besides that, the application of ice can cause a short decrease in pain and in swelling. Even though cryotherapy 2, 5 was not studied very thoroughly, recent research has shown that for injuries of soft tissue, applications of ice through a wet towel for ten minutes are the most effective measures. Active rehabilitation, An active exercise program mostly includes eccentric exercises. This can be explained by the fact that eccentric muscle training will lengthen the muscle fibres, which stimulates the collagen production. This form of therapy appears successful for mid-portion tendinosis, but has less effect with insertion tendinopathy. The sensation of pain sets the beginning burdening of the patient and the progression of the exercises.
Surgical Treatment
Chronic Achilles tendon tears can be more complicated to repair. A tendon that has torn and retracted (pulled back) into the leg will scar in the shortened position over time. Restoring normal tendon length is usually not an issue when surgery is performed within a few weeks of the injury. However, when there has been a delay of months or longer, the treatment can be more complicated. Several procedures can be used to add length to a chronic Achilles tear. A turndown procedure uses tissue folded down from the top of the calf to add length to the Achilles tendon. Tendon transfers from other tendons of the ankle can also be performed to help restore function of the Achilles. The results of surgery in a chronic situation are seldom as good as an acute repair. However, in some patients, these procedures can help restore function of a chronically damaged Achilles.
Prevention
As with all injuries, prevention is your best defense especially with injuries that are as painful and inconvenient as Achilles tendonitis. Options for how to prevent Achilles tendonitis include, stretching- Stretching properly, starting slowly, and increasing gradually will be critical if you want to avoid Achilles tendonitis. To help maintain flexibility in the ankle joint, begin each day with a series of stretches and be certain to stretch prior to, and after, any exercise or excessive physical activity. Orthotics and Heel Support- Bio-mechanically engineered inserts and heel cups can be placed in your shoes to correct misalignments or bolster the support of your foot and are available without a prescription. The temporary heel padding that these provide reduces the length that the Achilles tendon stretches each time you step, making it more comfortable to go about your daily routine. Proper Footwear- Low-heeled shoes with good arch support and shock absorption are best for the health of your foot. Look into heel wedges and other shoe inserts to make sure that your everyday foot mechanics are operating under ideal conditions.
Achilles tendinitis is an uncomfortable condition where a person?s large tendon in the back of their ankle becomes irritated and inflamed. It is a very common type of injury, most often seen in recreational athletes. This makes sense because recreational athletes still play hard at their sports, but don?t have the full knowledge or training that comes with being a professional to prevent injuries. Achilles tendon pain is not something to be taken lightly, so if you are aware of your own, you should definitely seek some medical advice.
Causes
In some cases, Achilles Tendinitis can be caused by physical activity without a proper warm up or trauma, such as falling, to cause an overstressing of the muscle and tendon. Other causes include repetitive overuse syndrome, such as a job that required frequent heel lifting. Biomechanical causes such as pronation (or fallen arches) will cause the heel (calcaneus) to lean slightly, putting the undue stress on the Achilles tendon and the calf muscles. Most pain can be felt at the back of the heel or the point at which the calf muscle becomes a tendon three quarters of the distance down from the knee. Discomfort can be felt especially when jumping or when lifting the heel off the ground. Swelling and redness can often be seen at the back of the heel and touching the area would cause a tender sensation. In extreme cases, the tendon can become torn or rupture entirely which would cause bruising or an inability to put pressure on the foot.
Symptoms
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.
Diagnosis
There is enlargement and warmth of the tendon 1 to 4 inches above its heel insertion. Pain and sometimes a scratching feeling may be created by gently squeezing the tendon between the thumb and forefinger during ankle motion. There may be weakness in push-off strength with walking. Magnetic resonance imaging (MRI) can define the extent of degeneration, the degree to which the tendon sheath is involved and the presence of other problems in this area, but the diagnosis is mostly clinical.
Nonsurgical Treatment
In order to treat the symptoms, antiflogistics or other anti-inflammatory therapy are often used. However these forms of therapy usually cannot prevent the injury to live on. Nevertheless patients will always have to be encouraged to execute less burdening activities, so that the burden on the tendon decreases as well. Complete immobilisation should however be avoided, since it can cause atrophy. Passive rehabilitation, Mobilisations can be used for dorsiflexion limitation of the talocrural joint and varus- or valgus limitation of the subtalar joint. Deep cross frictions (15 min). It?s effectiveness is not scientifically proven and gives limited results. Recently, the use of Extracorporal Shock Wave Therapy was proven. Besides that, the application of ice can cause a short decrease in pain and in swelling. Even though cryotherapy 2, 5 was not studied very thoroughly, recent research has shown that for injuries of soft tissue, applications of ice through a wet towel for ten minutes are the most effective measures. Active rehabilitation, An active exercise program mostly includes eccentric exercises. This can be explained by the fact that eccentric muscle training will lengthen the muscle fibres, which stimulates the collagen production. This form of therapy appears successful for mid-portion tendinosis, but has less effect with insertion tendinopathy. The sensation of pain sets the beginning burdening of the patient and the progression of the exercises.
Surgical Treatment
Chronic Achilles tendon tears can be more complicated to repair. A tendon that has torn and retracted (pulled back) into the leg will scar in the shortened position over time. Restoring normal tendon length is usually not an issue when surgery is performed within a few weeks of the injury. However, when there has been a delay of months or longer, the treatment can be more complicated. Several procedures can be used to add length to a chronic Achilles tear. A turndown procedure uses tissue folded down from the top of the calf to add length to the Achilles tendon. Tendon transfers from other tendons of the ankle can also be performed to help restore function of the Achilles. The results of surgery in a chronic situation are seldom as good as an acute repair. However, in some patients, these procedures can help restore function of a chronically damaged Achilles.
Prevention
As with all injuries, prevention is your best defense especially with injuries that are as painful and inconvenient as Achilles tendonitis. Options for how to prevent Achilles tendonitis include, stretching- Stretching properly, starting slowly, and increasing gradually will be critical if you want to avoid Achilles tendonitis. To help maintain flexibility in the ankle joint, begin each day with a series of stretches and be certain to stretch prior to, and after, any exercise or excessive physical activity. Orthotics and Heel Support- Bio-mechanically engineered inserts and heel cups can be placed in your shoes to correct misalignments or bolster the support of your foot and are available without a prescription. The temporary heel padding that these provide reduces the length that the Achilles tendon stretches each time you step, making it more comfortable to go about your daily routine. Proper Footwear- Low-heeled shoes with good arch support and shock absorption are best for the health of your foot. Look into heel wedges and other shoe inserts to make sure that your everyday foot mechanics are operating under ideal conditions.
