Achilles Tendon Sheath Infection

Overview
Achilles-tendinitis is characterized by inflammation and pain at the Achilles tendon (back of the ankle). This tendon, sometimes called the heel cord, is the tendon attachment of the calf muscles from the leg and knee to the heel. This structure is important in standing on your toes or in the pushing-off phase of walking, running, or jumping.Achilles-tendinitis is usually a grade 1 or 2 strain of the tendon. A grade 1 strain is a mild strain. There is a slight pull of the tendon without obvious tendon tearing. (There is microscopic tendon tearing.) There is no loss of strength, and the tendon is the correct length. A grade 2 strain is a moderate strain. There is tearing of tendon fibers within the substance of the tendon or where the tendon attaches to muscle or bone. The length of the tendon or whole muscle-tendon-bone unit is increased, and there is usually decreased strength. A grade 3 strain is a complete rupture of the tendon.

Causes
Achilles tendinitis can be caused by any activity that puts stress on your Achilles tendon. Tendinitis can develop if you run or jump more than usual or exercise on a hard surface. Tendinitis can be caused by shoes that do not fit or support your foot and ankle. Tight tendons and muscles, You may have tight hamstring and calf muscles in your upper and lower leg. Your tendons also become stiffer and easier to injure as you get older. Arthritis, Bony growths caused by arthritis can irritate the Achilles tendon, especially around your heel.

Symptoms
The main complaint associated with Achilles tendonitis is pain behind the heel. The pain is often most prominent in an area about 2-4 centimeters above where the tendon attaches to the heel. In this location, called the watershed zone of the tendon, the blood supply to the tendon makes this area particularly susceptible. Patients with Achilles tendonitis usually experience the most significant pain after periods of inactivity. Therefore patients tend to experience pain after first walking in the morning and when getting up after sitting for long periods of time. Patients will also experience pain while participating in activities, such as when running or jumping. Achilles tendonitis pain associated with exercise is most significant when pushing off or jumping.

Diagnosis
A podiatrist can usually make the diagnosis by clinical history and physical examination alone. Pain with touching or stretching the tendon is typical. There may also be a visible swelling to the tendon. The patient frequently has difficulty plantarflexing (pushing down the ball of the foot and toes, like one would press on a gas pedal), particularly against resistance. In most cases X-rays don't show much, as they tend to show bone more than soft tissues. But X-rays may show associated degeneration of the heel bone that is common with Achilles Tendon problems. For example, heel spurs, calcification within the tendon, avulsion fractures, periostitis (a bruising of the outer covering of the bone) may all be seen on X-ray. In cases where we are uncertain as to the extent of the damage to the tendon, though, an MRI scan may be necessary, which images the soft tissues better than X-rays. When the tendon is simply inflamed and not severely damaged, the problem may or may not be visible on MRI. It depends upon the severity of the condition.

Nonsurgical Treatment
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.



Surgical Treatment
Surgery is considered the last resort and is often performed by an orthopedic surgeon. It is only recommended if all other treatment options have failed after at least six months. In this situation, badly damaged portions of the tendon may be removed. If the tendon has ruptured, surgery is necessary to re-attach the tendon. Rehabilitation, including stretching and strength exercises, is started soon after the surgery. In most cases, normal activities can be resumed after about 10 weeks. Return to competitive sport for some people may be delayed for about three to six months.

Prevention
Appropriately warm up and stretch before practice or competition. Allow time for adequate rest and recovery between practices and competition. Maintain appropriate conditioning, Ankle and leg flexibility, Muscle strength and endurance, Cardiovascular fitness. Use proper technique. To help prevent recurrence, taping, protective strapping, or an adhesive bandage may be recommended for several weeks after healing is complete.